Kawasaki Diseases: Differential Diagnoses

Alternative diagnosis Note: This list is not exhaustive and the full clinical picture must be considered	Classic features	Testing to consider (in addition to labs for KD diagnosis) and additional resources
Sepsis	Temperature instability/fever Lethargy Tachycardia Tachypnea Hypotension Poor perfusion Cyanosis Mottled skin	See Sepsis Clinical Pathway
Tickborne illness (e.g., Erlichia, Rocky Mountain Spotted Fever)	Maculopapular and/or petechial rash which may start on wrists/ankles Rash on palms and soles Possible tick exposure (although lack of tick exposure does not exclude this diagnosis)	See Tickborne Illness Clinical Pathway
Stevens-Johnson syndrome or Toxic Epidermal Necrolysis (due to medication or infection)	Concerning medication exposure Urticaria Bullae/vesicular rash Positive Nikolsky sign Mucous membrane involvement	Dermatology consult Clinical Pharmacy consult
Toxin-mediated disease (including Staphylococcal Scalded Skin Syndrome, Staphylococcal or streptococcal toxin- mediated disease)	Hemodynamic instability Sunburn-like rash Skin desquamation Lab abnormalities including end organ involvement Mucous membrane involvement, including conjunctivitis Mental status changes	Blood culture
Streptococcal scarlet fever	Pharyngitis Erythematous rash, which can become fine flaking desquamating rash on extremities Cervical lymphadenopathy	Rapid Strep test, Throat culture
Measles	Under immunized Cough Coryza Maculopapular rash spreading head to toe then extremities Koplik spots Possible exposure Local outbreaks	See Measles Clinical Pathway
Respiratory viral infections (e.g., Adenovirus, Enterovirus, Parvovirus B19)	Cough Nasal congestion Fever Vomiting/diarrhea Sunburn-like rash (adenovirus), “slapped cheek” rash or papular-purpuric gloves-and-socks eruption (Parvovirus) Viral exanthem Arthralgias Malaise Decreased appetite Exudative conjunctivitis	Respiratory viral testing, or other virus-specific tests
Epstein-Barr Virus	Malaise Headache Fever Exudative pharyngitis Tender bilateral anterior and posterior cervical lymphadenopathy Abdominal pain	EBV Ab Monospot (if age >4 years)
Bartonella Ab	Lymphadenopathy Cat exposure	Bartonella Ab
Leptospirosis	GI symptoms Conjunctivitis	Leptospira IgM
Rat Bite Fever	Arthralgias Arthritis Lymphadenopathy Rash Possible rat exposure	Blood culture (collect 2x recommended volume per patient weight)
Serum Sickness and Serum Sickness-Like Reaction	Recent exposure to common trigger, such as antibiotics (e.g., amoxicillin)
Systemic Juvenile Idiopathic Arthritis	Classic features Quotidian fevers Rash that comes and goes with fever Arthritis Lymphadenopathy Serositis Hepatosplenomegaly	Ferritin LDH Fibrinogen Quantiferon TB (needed prior to treatment)

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.

Kawasaki Diseases: Differential Diagnoses

Alternative diagnosis

Classic features

Testing to consider (in addition to labs for KD diagnosis) and additional resources

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