The second possibility, and the more likely one, is that the patient has Kawasaki syndrome (KS). His collective symptoms and signs meet the criteria for this syndrome, which is diagnosed on clinical grounds.1 He has had 9 days of fever, a single swollen lymph node, pharyngeal erythema, red and cracked lips, and swollen hands and feet. Although he does not have a rash now, the parents reported one earlier in the illness, and the rash of KS may be early and transient. The only criterion that he lacks is conjunctivitis. Irritability, lethargy, and poor eating may be seen in patients with KS, but these are very nonspecific features. Findings from the laboratory studies are also consistent with KS. His ESR is elevated and his platelet count is normal, which is expected early in the illness. Sterile pyuria is often present. Finally, CSF pleocytosis is consistent with the aseptic meningitis observed in patients with KS. What is atypical is the late onset of lip changes and hand and foot swelling. Up to that point, although he had 8 days of persistent fever, a single enlarged lymph node, and a history of a transient rash, he did not meet criteria for KS. Incomplete or atypical KS has been described in young infants, usually younger than 6 months.2 The other striking features that appeared early on were distractions from the diagnosis of KS.