Which cluster of signs is described by the acronym Warm + CREAM in Kawasaki disease?

• A. Chest pain, Renal failure, Edema, Arthralgia, Malaise
• B. Cough, Rhinorrhea, Eczema, Allopecia, Meningitis
• C. None of the above
• D. Conjunctivitis, Rash, Extremity changes, Adenopathy, Mucous membrane changes

Answer: (D)

Kawasaki disease is diagnosed when a child has fever for at least 5 days plus four of the five principal clinical features. The mnemonic Warm + CREAM encodes these signs: fever (Warm) plus Conjunctivitis, Rash, Extremity changes, Adenopathy, and Mucous membrane changes. The cluster described by this acronym precisely matches the classic clinical criteria, making it the best choice. The other option lists signs that aren’t characteristic of Kawasaki disease (for example, respiratory or systemic symptoms not part of the typical mucocutaneous pattern), so they don’t fit the diagnostic pattern. Recognizing this constellation is important because timely treatment with IVIG and aspirin reduces the risk of coronary artery complications.