Kawasaki disease (KD) is an acute medium-vessel vasculitis of unknown aetiology, primarily affecting children < 5 years. Without treatment, 20-25% develop coronary artery aneurysms; with timely IVIG (within 10 days), this falls to ~4%.

India's KD incidence is rising — estimated 4-7 per 100,000 children < 5 yr, much lower than Japan (~300/100,000) but likely under-diagnosed. BCG-site erythema is a characteristic finding in Indian KD due to universal BCG vaccination.

Classic KD: Fever ≥ 5 days + ≥ 4 of 5 principal features:

1. Bilateral bulbar conjunctival injection
2. Oral mucous membrane changes (cracked red lips, strawberry tongue)
3. Polymorphous rash
4. Extremity changes (erythema, oedema, peeling)
5. Cervical lymphadenopathy ≥ 1.5 cm

Incomplete KD: Fever ≥ 5 days + 2-3 principal features + supportive labs OR echo abnormalities. Use AHA 2017 algorithm to decide.

• IVIG 2 g/kg single infusion over 10-12 hours, ideally within 10 days of fever onset (still beneficial later if active inflammation).
• Aspirin 30-50 mg/kg/day in 4 divided doses until afebrile 48-72 h, then 3-5 mg/kg/day until normal echo at 6-8 weeks.
• IVIG-resistant KD (persistent fever > 36 h post-IVIG, ~15-20%): second IVIG dose OR IV methylprednisolone 30 mg/kg × 3 days OR infliximab 5-10 mg/kg.
• Echo: baseline, day 14, 6-8 weeks. Z-score ≥ 2.5 or aneurysm = abnormal.

• IVIG cost: ₹40,000-80,000 for a typical 10-15 kg child (2 g/kg). Major financial barrier; PMJAY covers KD in some states.
• Aspirin: ₹2-5 per tablet — cheap and universally available (Disprin, ASA-75).
• BCG site erythema is a useful clue in Indian KD — appears in 30-50% of cases.
• Differentiate from MIS-C (post-COVID multisystem inflammatory syndrome) — older children, GI symptoms prominent, cardiac dysfunction more than aneurysms.
• PGIMER (Chandigarh) and AIIMS publish Indian KD registries.