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targetoid lesions of the trunk and extremities. Vesicular or bullous lesions are rare.
Changes in the extremities are generally the last clinical manifestation of KD to
develop. Children demonstrate an indurated edema of the dorsum of their hands and
feet, and a diffuse erythema of their palms and soles ( Fig. 101.13 ). During the
convalescent phase of KD, sheet-like desquamation that begins in the periungual region
of the hands and feet is characteristic ( Fig. 101.14 ). Linear nail creases known as
Beau lines are also common late manifestations of KD.
As a systemic vasculitis, KD may cause a variety of other clinical manifestations.
Pulmonary involvement may lead to symptoms such as cough and infiltrates,
peribronchial cuffing, and pleural effusions on chest radiographs. GI signs may range
from emesis and diarrhea to findings suggestive of an acute surgical abdomen.
Neurologic involvement has been reported, including aseptic meningitis, seizures,
facial nerve palsies, ataxia, hemiplegia, and severe encephalopathy. In general, as with
other vasculitides, manifestations of KD may be extremely variable, so clinicians
should not exclude the possibility solely on the basis of atypical features.

FIGURE 101.12 Bilateral, nonexudative conjunctivitis with sparing of the limbus in Kawasaki
disease.