Kawasaki disease.

Kawasaki disease is an acute, multisystem illness that predominantly affects young children and has been described throughout the world. The triphasic course includes an initial phase of acute illness marked by high fever, conjunctival injection, oral changes, and erythematous rash. The second, subacute, phase begins with a decline of the acute findings and proceeds with desquamation of rash, joint manifestations, thrombocytosis, and cardiac disease. Most deaths (1 to 2 percent of cases) occur in this phase, usually resulting from myocardial infarction. During the third phase all signs of clinical illness subside. The prognosis is related to the degree of cardiac involvement, and 14 to 20 percent of patients develop coronary artery aneurysms. Inhibition of platelet aggregation, combined with symptomatic relief and supportive measures, forms the cornerstone of therapy. Family physicians need to be aware of this illness, particularly since it can no longer be considered rare.