A 1-year-old boy presents with fever, severe diaper rash, and swelling of hands and feet. What pathologic finding is most likely associated with his condition?

The presentation of a 1-year-old boy with fever, severe diaper rash, and swelling of hands and feet suggests a systemic inflammatory condition. The context here aligns well with a diagnosis of Kawasaki disease, which is characterized by a number of distinctive features, including fever, rash, lymphadenopathy, and inflammatory changes in blood vessels.

The correct association is with granulomas and caseous necrosis. In Kawasaki disease, the significant pathological findings involve inflammation of the medium-sized muscular arteries (such as the coronary arteries), which can lead to the formation of granulomatous inflammation. This granulomatous response often includes areas of caseous necrosis, which is a type of tissue necrosis commonly associated with infections like tuberculosis.

In Kawasaki disease, the acute inflammation can also lead to sequelae such as cardiac complications, but the presence of granulomas with caseous necrosis distinctly fits the pathological changes that occur due to the autoimmune and inflammatory response triggered by the illness.

Other options do not align as precisely with the symptoms or the typical pathological findings associated with the clinical presentation in this scenario. Granulomatous arteritis might be considered in some contexts, but specifically linking it to Kawasaki disease with the inclusion of caseous necrosis is more accurate based on