Kawasaki disease presenting with severe airway obstruction: a case report

Kawasaki disease is an acute systemic vasculitis primarily affecting children, typically presenting with persistent fever, rash, conjunctival injection, and oral mucosal changes. Although pharyngeal involvement may occur, severe upper airway obstruction requiring mechanical ventilation is extremely rare. We report a pediatric case of Kawasaki disease manifesting primarily as epiglottitis and laryngeal obstruction.

A 15-month-old boy presented with a 6-day history of persistent fever and a 1-day history of neck swelling and progressive dyspnea. At the time of admission, the child showed signs of laryngeal obstruction. Other findings were a rash, enlarged cervical lymph nodes, mild redness of the conjunctiva, cracked lips, and a strawberry tongue. Neck CT demonstrated extensive wall thickening and edema in the nasopharynx, oropharynx, and larynx. Fiberoptic laryngoscopy revealed extensive white pseudomembranes on the posterior pharyngeal wall and a congested, swollen, spherical epiglottis. During hospitalization, progressive respiratory distress required endotracheal intubation and mechanical ventilation. Sputum culture identified methicillin-resistant Staphylococcus aureus. The patient's condition stabilized after combination therapy with intravenous immunoglobulin, vancomycin, and aspirin. In the convalescent phase, thrombocytosis and desquamation of the fingertips and toes were observed, fulfilling the clinical diagnostic criteria for Kawasaki disease.

Although Kawasaki disease rarely causes epiglottitis, it should be considered as a differential diagnosis in children presenting with fever, neck swelling, and laryngeal obstruction. Early recognition and prompt initiation of immunomodulatory therapy can effectively control disease progression and prevent unnecessary surgical intervention.