Kawasaki disease: Differential diagnosis and prevention of coronary artery aneurysms

Kawasaki disease is an acute childhood vasculitis in which diagnostic uncertainty can have permanent coronary consequences. Its clinical features appear asynchronously, and incomplete presentations, particularly in young infants, may resemble common infections or multisystem inflammatory syndrome in children. This narrative critical review examines how differential diagnosis, coronary assessment, and treatment selection can prevent coronary artery aneurysms. PubMed/MEDLINE and the clinical statement and guideline repositories of the American Heart Association and American College of Rheumatology were consulted in 2026, with emphasis on pivotal randomized trials, contemporary guidance, and studies of coronary risk. Clinical recognition depends on serial examination, inflammatory laboratory findings, and echocardiography rather than a single confirmatory test. Prompt intravenous immunoglobulin remains the cornerstone of aneurysm prevention, whereas aspirin primarily addresses inflammation and platelet activity. Baseline coronary artery Z scores and age under six months identify patients who warrant closer surveillance and consideration of intensified initial anti-inflammatory treatment. However, randomized trials published in 2026 did not demonstrate coronary benefit from routinely adding prednisolone in unselected populations, limiting extrapolation from earlier high-risk trials. Persistent inflammation, evolving coronary dimensions, and long-term vascular sequelae require individualized follow-up. Effective prevention therefore combines timely recognition with reproducible coronary measurements, selective treatment intensification, and continuity of cardiovascular care.