Kawasaki Disease Presenting as Cervical Lymphadenitis and Retropharyngeal Abscess

Kim, Hyun Ah; Moon, Young Eun; Oh, Jae Gwuang; Lee, Sung Su; Lee, Seok Hee; Shim, Woo Sub; Lee, Dong Wook

Abstract

BACKGROUND AND OBJECTIVES
Kawasaki diseases (KD) sometimes present themselves as cervical lymphadenitis or deep neck infection. These unusual Kawasaki diseases then lead to unnecessary antibiotic therapy or surgical intervention or delaying therapy. The purpose of this study is to determine clinical characteristics of early expressions of atypical Kawasaki diseases presenting as deep neck infection.
SUBJECTS AND METHOD
We reviewed the medical records of the 6 patients who had been treated for Kawasaki disease that initially presented as fever and cervical lymphadenitis between March, 2007 and December, 2008.
RESULTS
The contrast neck CT scan of four of the cases revealed no ring enhancement but retropharyngeal space fluid collection suggestive of retropharyngeal abscess. The contrast neck CT scan of the other two cases showed homogenous nonsuppurative cervical lymph node enlargement. We administered intravenous antibiotics but patients did not response to them. We then immediately administered intravenous immunoglobulin and aspirin after making the diagnosis of Kawasaki disease. The clinical condition of all the cases improved dramatically with defervescence.
CONCLUSION
The possibility of Kawasaki disease should be considered in the following three situations: first, if the fever is refractory to intravenous antibiotic treatment in the febrile child with cervical lymphadenopathy, secondly, if the neck CT scan reveals a soft tissue swelling with no ring enhancement, and lastly, if the fever subsides dramatically after starting intravenous immunoglobulin and aspirin. Echocardiography should be performed as early as possible.