Incomplete Kawasaki Disease Mimicking Deep Neck Infection: A Case With Tracheal Deviation and Retropharyngeal Edema

Kawasaki disease (KD) is usually diagnosed based on its characteristic mucocutaneous manifestations. However, in incomplete KD, where these features are not fully present, diagnosis is often delayed, and differentiation from other conditions, such as deep neck infection, is crucial. We report the case of a four-year-old boy who presented with anterior cervical swelling and lateral tracheal deviation, initially suspected to have a deep neck infection. On the fourth day of fever, he exhibited left anterior cervical swelling, trismus, and imaging findings of retropharyngeal edema. Despite antibiotic therapy for presumed deep neck infection, fever persisted, and echocardiography revealed coronary artery dilatation, raising suspicion of KD. Intravenous immunoglobulin was administered, but fever persisted, necessitating the addition of cyclosporine, which led to defervescence and improvement of inflammatory markers. Consequently, a coronary artery aneurysm developed, and incomplete KD was diagnosed. To our knowledge, KD presenting with tracheal deviation has not been previously reported. This case underscores the diagnostic and therapeutic challenges posed by KD presenting with clinical features mimicking deep neck infection.