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Acute cervical lymphadenitis in a febrile child: when to think beyond infection?

Chaitra Govardhan1, Ashwini Prithvi1, Pradeesh Mappa2

  • 1Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK.

Archives of Disease in Childhood. Education and Practice Edition
|May 19, 2026
PubMed

Insights

Pediatric cervical lymphadenitis can mimic bacterial infections but may indicate Kawasaki disease. Early recognition of this

Area of Science:

  • Pediatric Rheumatology
  • Infectious Diseases
  • Clinical Diagnostics

Background:

  • Cervical lymphadenitis is a common pediatric presentation, often attributed to infection.
  • Inflammatory conditions, including Kawasaki disease and malignancy, can mimic cervical lymphadenitis.
  • 'Node-first' Kawasaki disease, where lymphadenopathy is the initial symptom, presents a diagnostic challenge.

Purpose of the Study:

  • To highlight 'node-first' Kawasaki disease as a critical differential diagnosis in pediatric cervical lymphadenitis.
  • To emphasize the importance of considering Kawasaki disease in febrile children with unresponsive cervical lymphadenitis.
  • To reduce diagnostic delays and potential complications associated with missed Kawasaki disease diagnoses.

Main Methods:

  • Case report of a 4-year-old boy with initial misdiagnosis of bacterial lymphadenitis.
  • Detailed description of the evolving clinical presentation, including conjunctival injection, erythema, mucosal changes, and elevated liver enzymes.
  • Review of diagnostic considerations for pediatric cervical lymphadenitis.

Main Results:

  • The patient's initial presentation of unilateral neck swelling was treated as bacterial lymphadenitis.
  • Development of characteristic Kawasaki disease features led to a delayed diagnosis in the second week.
  • Overlapping clinical and laboratory findings between infectious lymphadenitis and Kawasaki disease were observed.

Conclusions:

  • Febrile children with cervical lymphadenitis unresponsive to antibiotics warrant investigation for alternative diagnoses like Kawasaki disease.
  • Prompt recognition of 'node-first' Kawasaki disease is crucial to prevent complications.
  • Awareness of this rare presentation can improve diagnostic accuracy and patient outcomes.

Keywords:
Allergy and ImmunologyCardiologyChild HealthPaediatricsRheumatology

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