Introduction
Kawasaki Disease (KD), an acute febrile vasculitis of early childhood, is the leading cause of acquired heart disease in developed countries. African data is scarce with limited studies suggesting underdiagnosis rather than true lower incidence. To date there has been no comprehensive cohort descriptions of KD in South Africa. Our aim is to describe the clinical and demographic phenotype of KD in children admitted to a tertiary paediatric hospital in Cape Town South Africa in a 4-year period.

Methods
We performed a retrospective descriptive study of a paediatric cohort of children with KD (0–16 years) admitted to Red Cross Hospital from July 2020 – June 2024. All met the American Heart Association (AHA) criteria for KD and were enrolled in the Paediatric Rheumatology Biorepository which collected demographics, clinical features, laboratory findings, treatment and patient outcomes.

Results
Thirty-eight children with KD were included, median age of 20 months (range: 3 months-11 years). Fifty-two percent were black; 39% were South African coloured. The sex ratio was approximately equal (18F:20M). Common clinical features included fever (100%), rash (94.7%), tachycardia (92.1%), conjunctivitis (84.2%) and mucositis (84.2%). Median white cell count (17.72 x 10^9/L), C-reactive protein (132mg/L) and ferritin (270ug/L) were elevated, while the median haemoglobin (9.3g/dL), sodium (132mmol/L) and albumin (31g/L) were decreased compared to normal ranges.
Thirty-six children (94.73%) received intravenous immunoglobulin (IVIG) and 6/38 (15.7%) required 2 doses. Median time from symptom onset to IVIG was 7 days (range: 3-17). Forty percent received methylprednisolone (15/38) and 35 (92.1%) received aspirin. Median hospital stay was 6 days (range: 2-16). Four (10.5%) developed transient coronary artery aneurysms (CAA) and no patients died.

Conclusion
This is the largest single centre KD cohort from Africa which highlights the presence of disease and clinical phenotype in the region. These data demonstrate good outcomes, which we attribute to rapid diagnosis and timely administration of IVIG.