Background. Kawasaki disease(KD) is a systemic vasculitis, and monocytes have been suggested to play a role in the inflammatory process. To date, precise mechanisms leading to coronary artery lesions in KD are unknown. We hypothesized that expressions of Toll-like receptor (TLR)2 and TLR4 in monocytes are related to the development of coronary artery lesions(CALs) in patients with KD. Materials and Methods. We collected whole blood samples from 11 patients with KD before intravenous immunoglobulin (IVIG) treatment and 1 week afterward. Five age-matched febrile children were compared as controls. Expressions of TLR2 and TLR4 on circulating monocytes were compared using flow-cytometry. Results. Expression of TLR2 on CD14+monocytes were higher in patients with KD than in controls(1.26짹1.38% vs.0.87짹0.49%). TLR4 expression on CD14+monocytes were also higher in patients with KD than in controls(0.26짹0.30% vs. 0.22짹0.18%). No significant change in TLR2 and TLR4 expression were observed 1 week after IVIG therapy. Among patients with KD, both TLR2 and TLR4 expression levels were higher in patients who developed coronary artery lesions(CAL+) than those who did not(CAL-). Conclusion. TLR expression in circulating monocytes are correlated with the development of CALs in patients with KD. Modulation of TLR expression may be beneficial in preventing the occurrence of CALs in patients with KD.