Introduction: There has been no report of Kawasaki Disease (KD) complicated by ARDS in adults, the following documents a case of adult KD complicated by ARDS.

Clinical picture: a 36-year-old Chinese female experienced persistent high fever accompany by mucous membrane hyperemia , cervical lymph node enlargement , nonexudative conjunctivitis ,exanthema and periungal desquamation ,and progressive dyspnea with Hypoxemia .CT revealed diffuse pulmonary interstitial edema and consolidation.

Treatment: She was treated with mechanical ventilation, intravenous gamma globulin(30g/d) and oral aspirin.

Outcome:She was discharged well.

Conclusions: Adult KD complicated by ARDS is a rare condition. The clinical practitioner must be careful to avoid misdiagnosis. Aspirin and high dose gamma globulin remains the treatment of choice in addition to mechanical ventilation and other supportive therapy.