Cutaneous clues to Kawasaki disease: observations from seventeen pediatric patients

Abstract

Kawasaki disease (KD) is an acute pediatric vasculitis and a leading cause of acquired heart disease. Cutaneous manifestations are central to its diagnosis, yet variability in rash morphology and distribution may delay recognition, particularly in incomplete cases. Objective of the study was to describe the frequency, morphology, and distribution of cutaneous manifestations in pediatric patients with KD at a tertiary care center in Puerto Rico. We conducted a retrospective case series of pediatric patients diagnosed with classic or incomplete KD at Hospital Episcopal San Lucas in Ponce, Puerto Rico, between January 2019 and December 2024. Patients meeting American Heart Association diagnostic criteria were included. Clinical data focused on rash morphology, distribution, timing, and desquamation. Seventeen patients were included. All patients presented with fever. A polymorphous rash was observed in 15 patients (88.2%), most commonly morbilliform in appearance (82.4%). One patient exhibited a scarlatiniform rash, and two patients (11.8%) did not develop a rash. Rash involvement most frequently affected the trunk and extremities (64.7%), followed by the face (41.2%). Inguinal or perineal involvement occurred in 17.6% of cases. Desquamation was documented in 41.2% of patients, predominantly as periungual peeling during the subacute phase. Twelve patients (70.6%) met criteria for complete KD, while five (29.4%) had incomplete presentations. Cutaneous manifestations were common and largely consistent with classic KD patterns. Recognition of early or subtle dermatologuc findings is essential particularly in incomplete KD to enable timely diagnosis and reduce coronary complications.