From acute immune storm to lifelong vascular risk: a paradigm shift in Kawasaki disease as a chronic disease model

Based on accumulating evidence, this article proposes redefining Kawasaki disease as a chronic condition that begins with an acute immune response and leads to lasting vascular and immune dysfunction. This perspective moves beyond the traditional view of Kawasaki disease as a “self-limited vasculitis,” emphasizing that its pathological processes continue long after acute symptoms resolve. The disease follows a continuum involving persistent immune activation, ongoing low-grade inflammation, impaired blood vessel function, and metabolic changes. This chronic disease model explains why patients face accelerated atherosclerosis and higher long-term cardiovascular risk. The article systematically reviews the biology of the disease from its acute to chronic stages, summarizes supporting clinical and imaging evidence, and discusses the implications for lifelong patient management, personalized treatment strategies, and future research across multiple disciplines.