Kawasaki disease in 2019—past controversies, present insights and future directions

Kawasaki disease (KD) is a condition that is of interest to many pediatricians. Notwithstanding possible complications to coronary arteries, there is much that is yet unknown, including the controversies which surround this vasculitis. Making a timely and accurate diagnosis is essential for appropriate treatment, and incomplete KD adds a dimension to this complexity. While there are guidelines available for diagnosis, including clinical and echocardiographic findings, there is no definitive laboratory test, given the still unclear etiology. The best treatment option for recalcitrant disease is also debatable, as are the factors for those at high risk for coronary dilation. Although scoring systems are now available to risk stratify, these have variable success. It is envisaged that with the further development of novel biomarkers and genotyping, timely identification of those at risk will be a possibility. This article discusses evolution of our knowledge in KD over 5 decades, and reviews the advances which have been made.