Lymph-node-first Kawasaki disease obscured by deep neck infection in an infant

Fever, suppurative lymphadenitis, and suppurative parapharyngeal and mediastinal abscesses are typically indicative of deep neck infections. However, in rare instances, such deep neck infections may obscure underlying autoimmune conditions. This can lead to delayed or missed diagnosis with serious consequences. This case report describes the diagnostic uncertainty in a child presenting with suppurative deep neck and mediastinal abscesses concurrently with lymph-node-first Kawasaki disease features. Early clinical suspicion based on partial antibiotic response, timely detection of bilateral coronary artery dilatation and aneurysm, and prompt dual management with abscess drainage and intravenous immunoglobulin led to complete recovery of the child. This case highlights the importance of maintaining a high index of suspicion for Kawasaki disease in children with persistent lymphadenopathy and fever spikes despite intravenous antibiotics, while also recognizing the potential for true deep neck infection.