I have a fever again during the recovery period of Kawasaki disease

Kawasaki disease is clinically called pediatric mucocutaneous lymph node syndrome. It is more likely to occur in infants under five years old. Symptoms include fever, rash, non-purulent lymphadenopathy in the neck, conjunctival congestion, etc. Once it occurs, it must be treated promptly, otherwise complications such as shock and macrophage activation syndrome may occur. There are many treatment methods, but some patients will have fever again during the recovery period of Kawasaki disease.

The recurrence rate of Kawasaki disease is very low, less than 1%, and when it recurs, the patient still has the typical symptoms of Kawasaki disease. The treatment medications for recurrence of Kawasaki disease are basically the same as those for the initial onset, such as: injection of immunoglobulin, oral aspirin, etc.

The disease has a self-limiting course and most children have a good prognosis. For untreated children, 20%-30% may develop coronary artery tumors. Even with high-dose intravenous immunoglobulin treatment, about 15% of children still develop coronary artery disease. With timely diagnosis and treatment, the mortality rate has dropped to about 0.5%. About 1%-2% of children may relapse.

Because the rash of Kawasaki disease itself is polymorphic and non-specific, and pathogens such as adenovirus, Epstein-Barr virus, and enterovirus infected during colds can cause rashes similar to Kawasaki disease, the morphology of the rash alone is not sufficient to diagnose a recurrence of Kawasaki disease.

Kawasaki disease usually resolves spontaneously after 4-6 weeks. Patients without coronary artery disease have a good prognosis; those with fever duration >14 days, swelling and pain in large joints, use of corticosteroids, and white blood cell count >20×109/L have obvious heart damage. In patients with heart damage, coronary artery aneurysms usually shrink within one year, and the mortality rate does not exceed 2%. The mortality rate reported in Japan is 0.1%-0.2%. Death is generally difficult to predict; among those who die, 50% die within one month, 75% within two months, and 95% within six months after onset of the disease; there are also those who die suddenly ten years later or at other times. The residual damage of coronary artery involvement is not well understood and may precipitate premature atherosclerosis in the future.