A 2-year-old boy is brought to your morning surgery by his father who gives a history of a fever for 7 days associated with a rash. Clinical assessment suggests a possible diagnosis of Kawasaki’s disease. Which ONE of the following symptoms or signs supports the diagnosis of Kawasaki’s disease?

1. Changes in limb proximities

2. Unilateral conjunctivitis

3. Changes in the lips and oral cavity

4. Inguinal lymphadenopathy

5. Absence of a rash

An idiopathic self-limiting systemic vasculitis that most often affects children aged 6 months to 5 years. It is the leading cause of acquired heart disease in children in the developed world. In order to reach a diagnosis of Kawasaki disease, there must be a history of fever of at least 5 days' duration and at least 4 of the following 5 clinical features:

1. Inflammation and irritation of the lips, mouth and/or tongue (eg, cracked lips, strawberry tongue, inflamed mucosa of mouth or pharynx)

2. Erythema, oedema and/or desquamation of the extremities

3. Bilateral dry conjunctivitis

4. Widespread non-vesicular rash

5. Cervical lymphadenopathy > 1.5 cm in size

References

• Kawasaki disease (NHS Choices), Kawasaki disease (BMJ, 2014)