Antibiotic therapy may have been initiated for other diagnoses, but fever persists. The affected child usually is more irritable than would be expected by the degree of fever. Desquamation of the fingers and toes begins in the periungual region, may involve the palms and soles, and usually is observed 1-2 weeks after the onset of fever. The onset usually is abrupt with a high sustained fever that is unresponsive to antibiotic therapy and lasts for 1 week or longer. In addition, other typical features may be present.
Lips become erythematous and fissured.
Bleeding may be noted. The tongue is described as a strawberry tongue due to the diffuse erythema and prominent papillae. The neck is stiff, possibly leading to a workup for meningitis. Cardiac involvement ranges from myocarditis and pericarditis with or without effusion in the acute stage to the development of coronary artery aneurysms later in the course. Other clinical features of the disease may include arthritis, abdominal pain, pyuria, and gall bladder distention.