Antibiotic therapy may have been initiated for other diagnoses, but fever persists. The affected child is usually more irritable than would be expected by the degree of fever. This may limit movement and cause the child to refuse to bear weight. Desquamation of the fingers and toes begins in the periungual region, may involve the palms and soles and usually is seen 1-2 weeks after the onset of fever. 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 work-up 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.