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Kawasaki disease presenting as cervical lymphadenitis or deep neck infection

H T Kao1, Y C Huang, T Y Lin

  • 1Division of Pediatric Infectious Diseases, Chang-Gung Children's Hospital, Taoyuan, Taiwan.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|April 3, 2001
PubMed

Insights

Kawasaki disease can present with dominant cervical lymphadenopathy, especially in infants and young children. Consider Kawasaki disease in febrile children with enlarged lymph nodes unresponsive to antibiotics.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Rheumatology

Background:

  • Kawasaki disease (KD) is a leading cause of acquired heart disease in children.
  • Cervical lymphadenopathy is a common but not universal finding in KD.
  • Atypical presentations of KD can delay diagnosis and treatment.

Purpose of the Study:

  • To characterize a cohort of pediatric patients with Kawasaki disease whose initial presentation was dominated by cervical lymphadenopathy.
  • To highlight the importance of considering KD in the differential diagnosis of pediatric cervical lymphadenopathy.

Main Methods:

  • Retrospective review of medical records of 14 children diagnosed with Kawasaki disease.
  • Patients initially presented with symptoms suggestive of cervical lymphadenitis, cellulitis, or deep neck infection.
  • Data collected included age, diagnostic delay, treatment, and clinical outcomes.

Main Results:

  • Over a third of patients (35.7%) were younger than 5 months, and over half (57.1%) were older than 53 months.
  • The mean diagnostic delay was 8.2 days, with initial treatment using empiric antibiotics proving ineffective.
  • Three patients (21.4%) developed coronary artery lesions despite treatment with intravenous immune gamma globulin.

Conclusions:

  • Kawasaki disease should be suspected in children under 6 months or over 4 years presenting with fever and enlarged cervical lymph nodes.
  • Lack of response to empiric antibiotics in such cases warrants further investigation for KD.
  • Early recognition and treatment are crucial to prevent cardiac complications in Kawasaki disease.
Abstract

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