Incidence of Kawasaki disease in Japan is 10 times higher than in the United States. Approximately 10% of patients have atypical clinical presentations. Because echocardiographic or angiographic evidence of coronary artery complications is needed for diagnosis, such atypical cases often result in either delay or omission of intravenous gamma globulin therapy and higher incidence of coronary artery aneurysms than those patients with classical presentations. Despite ongoing research, no universally accepted etiologic theory exists today. Intravenous gamma globulin remains the mainstay of the acute phase treatment of Kawasaki disease. However, reported transmission of hepatitis C virus via a brand of intravenous gamm globulin leaves us with a lingering concern about the safety of this treatment. In terms of long-term follow-up, emergencence of a number of newer diagnostic modalities is promising and warrants careful evaluation. Surgical therapy for coronary artery disease needs to be approached cautiously.