Kawasaki disease (mucocutaneous lymph node syndrome) is an acute vasculitis of childhood carrying a 1–2 per cent mortality from cardiovasular complications. Despite the extensive literature on Kawasaki disease in paediatric journals, there has been a paucity of documentation in the otolaryngological literature. This is despite the fact that Kawasaki disease may present as an otolaryngological emergency before the diagnosis is established. We describe three cases of Kawasaki disease, all of which presented to the ENT department of this hospital within a period of two months. These cases illustrate the slow evolution characteristic of the disease and highlight the difficulties of diagnosis in the initial febrile stage. We emphasize the importance of considering the diagnosis when treating a young child with a pyrexia resistant to antibiotics, as prompt introduction of therapy may decrease the risk of fatal coronary artery or cardiac involvement.