What is the clinical presentation of the acute febrile stage of Kawasaki disease?

Updated: Jul 29, 2018
  • Author: Tina K Sosa, MD; Chief Editor: Russell W Steele, MD  more...
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The acute stage begins with an abrupt onset of fever and lasts approximately 7-14 days. The fever is typically high-spiking and remittent, with peak temperatures ranging from 102-104°F (39-40°C) or higher. This fever is not responsive to antibiotics and can persist for up to 3-4 weeks if untreated. With appropriate therapy with IVIG, the fever typically remits within 36 hours.

In addition to fever and the principal clinical features listed above, signs and symptoms of this phase may include the following:

  • Irritability (often out of proportion to the degree of fever and other symptoms)

  • Aseptic meningitis

  • Anterior uveitis

  • Otitis media

  • Myocarditis and pericarditis

  • Pneumonitis

  • Hepatic, renal, and GI dysfunction

  • Orchitis

  • Meatitis, vulvitis, urethritis

  • Perianal erythema and/or desquamation

Additionally, erythema and induration at the site of bacillus Calmette-Guérin (BCG) inoculation is commonly observed in Japan.

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