Adult Recurrence of Kawasaki Disease Mimicking Retropharyngeal Abscess

Abstract

Kawasaki disease (KD) is an acute, self-limited vasculitis of unknown etiology that occurs predominantly in young children (≤5 years of age). We herein report the case of an 18-year-old Japanese man with a history of incomplete KD during infancy; later, despite an initial diagnosis of retropharyngeal abscess, he was ultimately diagnosed with retropharyngeal edema associated with recurrent KD. Adult-onset or recurrent KD is an uncommon event, and retropharyngeal edema is a rare manifestation of this disease. Internists should be aware of the possibility of KD that mimics a retropharyngeal abscess, even in adult patients.

Parapharyngeal and retropharyngeal infections in children: Kawasaki disease needs vigilance

“… 28 Previous studies have found that the alterations caused by KD in MRI are most common due to vascular edema. 29 Ueda et al 30 believed that the posterior wall of the pharynx consists of loose connective tissue and is prone to edema. The swollen lymph nodes impair lymphatic circulation, and lymph accumulates in the posterior wall of the pharynx, forming a low-density edematous area.…”

Two Cases of Adult-onset Kawasaki Disease with a Difficult Diagnosis

“…AKD is said to present with specific symptoms that differ from those of infants. Table compares the results of the 26th National Kawasaki Disease Surveillance in 2021 with those of the AKD cases reported in Japan for which major symptoms have been described (2,(4)(5)(6)(7)(8)(9).…”

Magnetic resonance imaging accuracy before surgery in children with retropharyngeal abscesses

“…Imaging studies are also crucial for quantifying the purulent collections' dimension, better defining the need for surgery and the differential diagnosis of RPA with Kawasaki disease, 6,7 or calcific tendinitis 8 …”

“…Abnormalities suggestive of RPA are the presence of fluid-like opacities, gas collections, rim enhancement, soft tissue swelling, obliterated fat planes, mass effect and a scalloping form or irregularity of the abscess wall. [2][3][4][5] Imaging studies are also crucial for quantifying the purulent collections' dimension, better defining the need for surgery and the differential diagnosis of RPA with Kawasaki disease, 6,7 or calcific tendinitis. 8 Although CT is the imaging of choice in most cases, evidence reports a lack of association between abnormalities suggestive of RPA and pus drainage at surgery.…”