Atypical presentation of Kawasaki disease in young infants mimicking a retropharyngeal abscess

Kritsaneepaiboon, Supika; Tanaanantarak, Pattama; Roymanee, Supaporn; Lee, Edward Y.

doi:10.1007/s10140-011-1005-0

Cited by 14 publications

(10 citation statements)

References 11 publications

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“…IKD has fewer characteristic clinical features than KD, causing delays in diagnosis, missed diagnosis or misdiagnosis. Some IKD cases initially presented as only fever and cervical lymphadenopathy and accompanying retropharyngeal low-density areas on CT, mimicking deep neck infection [ 7 , 8 , 18 ]. These cases are frequently misdiagnosed as retropharyngeal abscesss due to atypical symptomatology.…”

Section: Discussionmentioning

confidence: 99%

“…Because the treatments of the two diseases are quite different and the diseases can be fatal if an appropriate treatment is not provided, distinguishing them is important. However, only a few case reports or case series have been reported in the literature [5][6][7][8][9][10][11][12], and very few retrospective casecontrol studies have been conducted in this regard. Here, our retrospective study afforded the unique opportunity to describe and compare IKD patients initially presenting with retropharyngeal abnormalities, typical KD patients without retropharyngeal abnormalities and retropharyngeal abscess patients from a single centre.…”

Section: Introductionmentioning

confidence: 99%

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Clinical features of Kawasaki disease initially mimicking retropharyngeal abscess: a retrospective analysis

et al. 2022

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Objective Incomplete Kawasaki disease (IKD) initially presenting as retropharyngeal abnormality is very rare and is prone to misdiagnosis and missed diagnosis, often leading to poor prognosis. Most patients were misdiagnosed with retropharyngeal abscesses. Here, we describe and compare IKD patients initially presenting with retropharyngeal abnormalities, typical KD patients without retropharyngeal abnormalities and retropharyngeal abscess patients. Methods We performed a retrospective case–control study comparing IKD patients initially presenting with retropharyngeal abnormalities to both KD patients without retropharyngeal abnormalities and retropharyngeal abscess patients admitted to Shenzhen Children’s Hospital between January 2016 and December 2021. Results We evaluated data from 10 IKD patients initially presenting with retropharyngeal abnormalities (Group A), 20 typical KD patients (Group B) and 16 surgical drainage confirmed retropharyngeal abscess patients (Group C). Compared to Group B, we observed that Group A was older and had a more intense inflammatory response. On the day of admission, Groups A and C had similar early clinical presentations, and there were no significant differences in any major signs or symptoms. Close observation for the development of new KD signs and symptoms and unresponsiveness to empirical antibiotic therapy after 3 days is extremely important. The CRP (p = 0.011), AST (p = 0.002) and ALT (p = 0.013) levels were significantly higher and the WBC (P = 0.040) levels were significantly lower in Group A than in Group C. Neck radiological findings, such as the presence of ring enhancement (p = 0.001) and mass effects on the airway, are also useful tools for distinguishing these two diseases. Conclusion The careful observation of the signs and symptoms of this disease and the comprehensive analysis of the laboratory tests and neck radiological findings may help clinicians become aware of retropharyngeal abnormality as an atypical presentation of KD. Then, unnecessary treatments could be reduced, and the occurrence of serious complications can be avoided.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical features of Kawasaki disease initially mimicking retropharyngeal abscess: a retrospective analysis

et al. 2022

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“…Deep neck inflammation is found in approximately 5% of head and neck manifestations in KD and is most likely underestimated due to the fact that signs and symptoms of retropharyngeal involvement, such as stridor, neck pain and dysphagia, are less common in KD than in retropharyngeal abscesses. Only a small proportion of patients undergo imaging studies [18,19].…”

Section: Discussionmentioning

confidence: 99%

A Case of Incomplete and Atypical Kawasaki Disease Presenting with Retropharyngeal Involvement

Isidori

Sebastiani

Esposito

2019

IJERPH

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Background: Kawasaki disease (KD) is a childhood acute febrile vasculitis of unknown aetiology. The diagnosis is based on clinical criteria, including unilateral cervical lymphadenopathy, which is the only presenting symptom associated with fever in 12% of cases. A prompt differential diagnosis distinguishing KD from infective lymphadenitis is therefore necessary to avoid incorrect and delayed diagnosis and the risk of cardiovascular sequelae. Case presentation: We describe the case of a 4 years old boy presenting with febrile right cervical lymphadenopathy, in which the unresponsiveness to broad-spectrum antibiotics, the following onset of other characteristic clinical features and the evidence on the magnetic resonance imaging (MRI) of retropharyngeal inflammation led to the diagnosis of incomplete and atypical KD. On day 8 of hospitalisation (i.e., 13 days after the onset of symptoms), one dose of intravenous immunoglobulins (IVIG; 2 g/kg) was administered with rapid defervescence, and acetylsalicylic acid (4 mg/kg/day) was started and continued at home for a total of 8 weeks. Laboratory examinations revealed a reduction in the white blood cell count and the levels of inflammatory markers, thrombocytosis, and persistently negative echocardiography. Clinically, we observed a gradual reduction of the right-side neck swelling. Fifteen days after discharge, the MRI of the neck showed a regression of the laterocervical lymphadenopathy and a resolution of the infiltration of the parapharyngeal and retropharyngeal spaces. Conclusion: Head and neck manifestations can be early presentations of KD, which is frequently misdiagnosed as suppurative lymphadenitis or retropharyngeal infection. A growing awareness of the several possible presentations of KD is therefore necessary. Computed tomography (CT) or MRI can be utilised to facilitate the diagnosis.

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“…RPE formation could be a risk factor for developing CAA. 10) The retropharyngeal space consists of lymphatic vessels and adipose tissue. This space was surrounded by alar and prevertebral fascia.…”

Section: Discussionmentioning

confidence: 99%

“…9) Reports of KD presenting as a retro-pharyngeal involvement such as cellulitis or abscess are rare. 4,6,[10][11][12][13] Neck computerized tomography (CT) of the neck is not a routine diagnostic modality for KD patients, just in case of severe cervical lymphadenopathy implying deep-neck infections. Thus, we could not know the true incidence of retropharyngeal space involvement in the overall KD cohort.…”

Section: Introductionmentioning

confidence: 99%

The Neglected Diagnosis in Retropharyngeal Abnormalities: Kawasaki Disease

Kwon¹,

Choi²

2017

J Clin Otolaryngol Head Neck Surg

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Background and Objectives：In patients with Kawasaki disease, retropharyngeal involvements (KDWRPI) is a rare complication. Most reported cases were diagnosed lately because those were often misdiagnosed as bacterial retropharyngeal abscess (BRA). The purpose of this study was to differentiate KDWRPI from BRA in advance. Materials and Methods：We performed a retrospective study comparing children with KDWRPI to those with BRA hospitalized at the university teaching hospital between January 2008 and September 2013. From our retrospectively collected database, we compared clinical, laboratory, and imaging characteristics of KDWRPI and BRA. Results: The study include 11 patients with retropharyngeal involvement on neck computerized tomography (CT) which were divided into two groups. Group A was classified as KDWRPI (n=6) and group B was classified as BRA (n=5). Compared with group B, patients with KDWRPI had lower sodium and albumin (p=0.0176 and 0.0828, respectively). Conclusions：Careful attention to manifestations and close analyses of laboratory findings and CT images may allow otorhinolaryngologists to differentiate KDWRPI from BRA. In the case of retropharyngeal edema on CT, the diagnosis of KDWRPI should not be neglected.

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Atypical presentation of Kawasaki disease in young infants mimicking a retropharyngeal abscess

Cited by 14 publications

References 11 publications

Clinical features of Kawasaki disease initially mimicking retropharyngeal abscess: a retrospective analysis

Clinical features of Kawasaki disease initially mimicking retropharyngeal abscess: a retrospective analysis

A Case of Incomplete and Atypical Kawasaki Disease Presenting with Retropharyngeal Involvement

The Neglected Diagnosis in Retropharyngeal Abnormalities: Kawasaki Disease

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