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Am Fam Physician. 2023;107(1):20-21

Author disclosure: No relevant financial relationships.

Details for This Review

Study Population: Children younger than 19 years diagnosed with Kawasaki disease (KD)

Efficacy End Points: The primary intervention outcome was any coronary artery abnormality found on cardiac angiography or echocardiography within three months of a KD diagnosis; abnormalities were defined by de Zorzi criteria (coronary lumen dimension 2.5 standard deviations or more above the mean for body surface area) or specified Japanese Ministry of Health criteria based on the patient's age and lumen diameter; secondary treatment outcomes included fever duration, length of hospitalization, and mortality

Harm End Points: Any serious adverse event attributable to the administration of corticosteroids

1 in 10 patients were helped (reduction in coronary artery abnormalities)No reported harms with corticosteroid use

Narrative: KD (i.e., mucocutaneous syndrome) is a multisystem vasculitis that may be related to an abnormal host response to an infection.1 Although KD is the leading cause of childhood-acquired heart disease in high-income countries, the incidence in children younger than five years varies, with 20.8 per 100,000 in the United States and 239.6 per 100,000 in Japan. Because there is no diagnostic test for KD, the diagnosis is based on clinical features or symptoms defined by the American Heart Association or the Japan KD Research Committee guidelines. Determining a diagnosis is challenging because clinical symptoms of KD are prevalent in common childhood viral illnesses (e.g., fever, rash, conjunctivitis, cervical lymphadenopathy).

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This series is coordinated by Christopher W. Bunt, MD, AFP assistant medical editor, and the NNT Group.

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