KD is a self-limited disease whose signs and symptoms evolve over the first 10 days of illness and then gradually resolve spontaneously in most children, even in the absence of specific therapy (26). Frequently, not all clinical criteria for KD are present on any given day. Moreover, there is no laboratory test that establishes the diagnosis, and clinicians must rely on history and physical examination to determine if patients meet clinical criteria. The development of coronary artery damage in up to 25% of untreated children is usually clinically silent and may only be recognized years later, at the time of a myocardial infarction or death (16). While the greatest concern is that KD is underdiagnosed, it is also likely that some degree of overdiagnosis occurs. Until there is a diagnostic test for KD, children will continue to be misdiagnosed and suffer preventable morbidity and mortality.

In a study from Japan, Tashiro et al. used transverse ultrasonographic evaluation of cervical lymph nodes with a 7.5- to 10-MHz transducer to distinguish between bacterial lymphadenitis, Epstein-Barr virus (EBV) infection, and KD (51). While sonograms of patients with EBV infection and KD revealed clusters of multiple, hypoechoic nodes forming a single palpable mass, sonograms of patients with documented bacterial lymphadenitis demonstrated a single, well-defined mass with a large, central hypoechoic region. Reports of computed tomography in KD patients with cervical node enlargement describe similar findings with multiple nodes forming a single, palpable mass (34,38,42).

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