Kawasaki disease should be distinguished from various rash infections, viral infections, acute lymphadenitis, rheumatoid diseases and other connective tissue diseases, viral myocarditis, and rheumatoid cardiitis.
1,Scarlet fever is characterized clinically by fever, pharyngitis, a diffuse bright red rash over the body, and marked desquamation after the rash recedes. The rash is similar to measles and erythema multiforme and begins on the third day after the onset of the disease, and penicillin is not effective.
2,Juvenile rheumatoid arthritis is characterized clinically by chronic arthritis, with systemic multi-system involvement and persistent irregular fever. Differentiate from this disease: the fever period is shorter, the rash is more transient, the patient’s hands and feet are hard and swollen, showing often plantar flushing; check rheumatoid factor is negative.
3,Exudative erythema multiforme is an acute non-purulent inflammatory disease related to immunity, characterized by diverse skin and mucous membrane manifestations. It is distinguished from the disease by the absence of purulent discharge and pseudomembrane formation in the eyes and lips of patients and the absence of blisters and crusts in the rash.
4,SLE is characterized by non-specific systemic symptoms, such as fever, especially low fever, general malaise, fatigue and weight loss. The rash is not significant on the patient’s face, and the total white blood cell count and platelets are generally elevated and negative for antinuclear antibodies.
5, rash viral infection mainly manifests with fever, headache, general malaise and other symptoms of systemic toxicity and local symptoms caused by inflammatory damage caused by viral host and invasion of tissues and organs. Differentiate from Kawasaki disease: the patient will appear lip flushing, dry cracking, bleeding, tongue prunus-like; hands and feet hard swelling, often plantar flushing and late appearance of finger and toe end membranous peeling; patient conjunctiva without edema or secretions; blood test total white blood cells and granulocyte percentage are increased, accompanied by nuclear left shift and blood sedimentation and C-reactive protein are significantly increased.
6, acute lymphadenitis clinical manifestations are lymph node enlargement, pain or pressure, not easy to push, the surface skin often has redness and edema, pressure pain is obvious, often accompanied by chills, fever, headache, general malaise and other symptoms. Differentiation from Kawasaki disease is that the patient’s cervical lymph nodes are swollen and less painful, and the local skin and subcutaneous tissues are not red, swollen, or septic lesions.
7,The clinical manifestations of viral myocarditis are fever, generalized aches and pains, sore throat, diarrhea and other symptoms before the onset of the disease, reflecting systemic viral infection. The patient is distinguished from Kawasaki disease by persistent high fever, characteristic hand and foot changes and prominent coronary artery lesions.
8,Rheumatic heart disease often has no obvious symptoms in the early stage of the disease, but in the later stage, it is characterized by shortness of breath, weakness, cough, edema of the limbs, and coughing up pink foamy sputum. Kawasaki disease is distinguished by its prevalence in infants and children, prominent coronary artery lesions and absence of a meaningful heart murmur.
9,Kawasaki disease has many similarities with the symptoms of infantile nodular polyartery class, but Kawasaki disease has more incidence of cutaneous mucosal lymph node syndrome, shorter course and better healing. The interrelationship of these two diseases has yet to be studied.