CRASH and Burn

Kawasaki Disease Signs and Symptoms Acronym

Author: Lily Guo, MD

Editor: Alyssa Haag, MD

Editor: Ian Mannarino MD, MBA

Editor: Kelsey LaFayette, DNP

Illustrator: Jannat Day

Modified: Jan 06, 2025

What is Kawasaki disease?

Kawasaki disease, also known as mucocutaneous lymph node syndrome, is a self-limiting medium-vessel vasculitis that primarily affects the coronary arteries. It is more common in children under 5 years of age, especially those of Asian or Pacific Islander descent and is one of the leading causes of heart disease in children. While the etiology is not well understood, various bacterial and viral organisms are suspected to be risk factors for developing Kawasaki disease. A pathogen causes a respiratory infection that then triggers an immune response consisting of lymphocytes, cytokines, and neutrophils. Most individuals affected by Kawasaki disease have benign symptoms. However, coronary artery aneurysms (i.e., widening and weakening of the wall of a coronary artery) develop in 20-25% of untreated patients, which can result in damage to the heart muscle and heart valve, myocardial infarction, rupture, pericardial effusion, cardiac tamponade, dysrhythmias, or even death. Therefore, treatments for Kawasaki disease (i.e., aspirin and intravenous immunoglobulin [IVIG]) are administered promptly once the diagnosis is made.

An infographic detailing the signs and symptoms of Kawasaki disease using the CRASH and Burn acronym.

What is CRASH and Burn?

CRASH and Burn is an acronym that describes the diagnostic criteria, signs, and symptoms of Kawasaki disease, namely conjunctivitis, rash, adenopathy, strawberry tongue, hand and feet swelling, and burn, or fever for 5 or more consecutive days. On history and physical examination, the individual must have fevers for 5 or more days, and at least four of the five criteria outlined in the CRASH acronym to diagnose Kawasaki disease. However, those who fall short of the full criteria but have cardiac abnormalities on echocardiogram meet the diagnosis of Kawasaki disease.

What does the “C” in CRASH and Burn mean?

The “C” in CRASH and Burn refers to conjunctivitis, or inflammation of the conjunctiva, the mucous membrane covering the whites of the eyes. This results in red and swollen whites of the eyes. The conjunctivitis associated with Kawasaki disease is usually bilateral, painless, and lacks exudate, or fluid leakage. It can also present with photophobia or sensitivity to light and be associated with uveitis, which is inflammation of the uvea, the middle layer of the eyes, in 65% of individuals.

What does the “R” in CRASH and Burn mean?

The “R” in CRASH and burn refers to rash. Individuals with Kawasaki disease typically have a patchy, generalized, macular (i.e., flat), erythematous rash over the trunk and extremities. There is predilection for the lower abdomen, groin, perineum (i.e., area between the anus and the scrotum/vulva), and buttocks. The rash is typically not itchy. In addition to the erythematous rash, there may be desquamation (i.e., skin peeling) of the periungual area (i.e., the skin around a fingernail or toenail) starting 2 to 3 weeks after the onset of fever. In addition to the rash, nail changes, specifically horizontal grooves known as Beau’s lines, can be seen on over 75% of individuals.

What does the “A” in CRASH and Burn mean?

The “A” in CRASH and Burn refers to adenopathy or swelling of the lymph node in the neck larger than 1.5 centimeters (cm) in diameter. Adenopathy is usually unilateral, occurring only on one side of the neck, and can be palpated on physical examination.

What does the “S” in CRASH and Burn mean?

The “S” in CRASH and Burn refers to strawberry tongue, where the tongue appears swollen, red, and bumpy, sometimes with white patches-making it look like a strawberry. In addition to the strawberry tongue, the lips can be inflamed, fissured, and cracked.

What does the “H” in CRASH and Burn mean?

The “H” in CRASH and Burn refers to hand and feet swelling. The swelling is usually accompanied by erythema of the palms and soles, and then eventually desquamation of the skin. The individual may also report that their hands and feet are tender and painful to touch or put weight on.

What does the “Burn” in CRASH and Burn mean?

The Burn in the acronym CRASH and Burn refers to a fever of at least 5 days. Persistent fever is the most consistent presentation of Kawasaki disease, is minimally responsive to antipyretics (e.g., acetaminophen), and typically remains higher than 38.5 degrees Celsius (101.3 Fahrenheit). The onset of fever is usually abrupt and can last up to 3 to 4 weeks if left untreated.

What are the most important facts to know about the CRASH and Burn acronym?

CRASH and Burn is an acronym used to describe the disease symptoms and the diagnostic criteria for Kawasaki disease, a disease that affects medium-sized blood vessels, especially the coronary arteries. It primarily affects children of Asian or Pacific Islander descent and can lead to serious heart complications if untreated. The symptoms of Kawasaki disease include conjunctivitis, rash, adenopathy, strawberry tongue, hand and feet swelling, and fever for 5 or more days. Prompt diagnosis and treatment of Kawasaki disease is important to prevent long term damage to the heart.

References

Kawasaki Disease. Kawasaki Disease Foundation. Published 2018. https://kdfoundation.org/

Kimberlin DW, Long SS, Brady MT, Jackson MA. Kawasaki disease. In: Kimberlin DW, Long SS, Brady MT, Jackson MA, eds. Red Book 2018: Report of the Committee on Infectious Diseases. 31st ed. Itasca, IL: American Academy of Pediatrics; 2018:490-496.

McCrindle BW, Rowley AH, Newburger JW, et al; American Heart Association rheumatic fever, endocarditis, and Kawasaki disease; Cardiovascular and stroke nursing; Council on cardiovascular surgery and anesthesia; and Council on epidemiology and prevention. Diagnosis, treatment, and long-term management of Kawasaki disease: A scientific statement for health professionals from the American Heart Association. Circulation. 2017 Apr 25;135(17):e927-e999. PubMed ID: 28356445

Yim D, Curtis N, Cheung M, Burgner D. An update on Kawasaki disease II: Clinical features, diagnosis, treatment and outcomes. J Paediatr Child Health. 2013 Aug;49(8):614-23. doi: 10.1111/jpc.12221. Epub 2013 May 7. PMID: 23647873.