CRASH & Burn the heart
Imagine a 5 month to 5-year-old child riding a Kawasaki motorcycle. He is using his hands and feet to do it. He has been riding and burning for 5 days and is going to CRASH and burn his heart.
Typical (Complete) Kawasaki
The diagnostic criteria for typical (complete) Kawasaki disease is a fever for at least 5 days and at least 4 of 5 principal clinical features. The clinical features include:
- Conjunctivitis – Bilateral non-purulent conjunctivitis (Bilateral bulbar conjunctivitis without exudates).
- Rash – Polymorphous rash: maculopapular, erythema multiforme–like or scarlatiniform rash, involving the extremities, trunk, and perineal regions
- Adenopathy in the cervical region -Cervical adenopathy (>1.5 cm in diameter and generally unilateral)
- Strawberry tongue – Changes of the oral cavity and lips: cracked erythematous lips, strawberry tongue
- Hands & Feet peel (Desquamation) – Changes in the extremities (erythema of the hands and feet, desquamation of the hands and toes in weeks 2 and 3)
Must exclude other diseases with similar findings.
Explanation of the mnemonic
Burn = Fever (lasting over five days).
Fever lasting five days plus four out of five CRASH symptoms suggests Kawasaki. Note that doesn’t irrefutably diagnose Kawasaki. Step Pharyngitis leading to Scarlet fever will have all of most of the same symptoms. The history will be different, however.
Atypical (incomplete) Kawasaki
Patients who lack enough classic findings to meet the criteria for classic or typical KD may have incomplete KD.The diagnostic criteria for atypical (incomplete) Kawasaki disease is a fever for at least 5 days and only 2 or 3 of the five principal clinical features.
Algorithm for Evaluating Atypical Kawasaki Disease from the AHA (2017).
References
Korean Journal of Pediatrics. 2012;55(3):83-87. Diagnosis of incomplete Kawasaki disease. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3315623/