Pediatric inflammatory multisystem syndrome (PIMS) presenting with retropharyngeal phlegmon mimicking Kawasaki disease

Gupta, Purbasha; Giri, Prabhas Prasun; Das, Dipankar; Pal, Priyankar

doi:10.1007/s10067-020-05538-x

Cited by 11 publications

(11 citation statements)

References 5 publications

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“…11 Additional case reports and series demonstrated similar findings. 12–22 Our case and review of other reported cases strengthens the evidence of association between retropharyngeal inflammation and MIS-C. Absence of an association of retropharyngeal inflammation and MIS-C in the literature might have led to a relatively late diagnosis in some patients such as occurred with our patient.…”

Section: Discussionsupporting

confidence: 83%

Retropharyngeal involvement in multisystem inflammatory syndrome in children: Case report and review of literature

Oliva

Ibrahim

McCormick

et al. 2022

SAGE Open Medical Case Reports

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A diagnosis of multisystem inflammatory syndrome in children should be made in the appropriate context and after ruling out other infectious causes. At the same time, clinicians should be diligent as the initial presentation can be unusual and the clinical picture can evolve over time. We report a case that was initially diagnosed as a retropharyngeal infection that did not improve on appropriate antimicrobial coverage. However, as the clinical picture evolved, the patient was found to have multisystem inflammatory syndrome in children and appropriately responded to immunomodulatory treatment. Pediatric infectious diseases practice has been significantly affected by the COVID-19 virus and multisystem inflammatory syndrome in children; data are still emerging as the pandemic evolves. We report this case and conduct literature review to expand the body of evidence about the association between multisystem inflammatory syndrome in children and retropharyngeal involvement.

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Section: Discussionsupporting

confidence: 83%

Retropharyngeal involvement in multisystem inflammatory syndrome in children: Case report and review of literature

Oliva

Ibrahim

McCormick

et al. 2022

SAGE Open Medical Case Reports

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“…[19][20][21] To date there have only been anecdotal case reports reporting deep neck infection in children associated with SARS-CoV-2. [11][12][13][14]22 In our cohort, 13.5% of patients had cervical manifestation as a primary presentation.…”

Section: Discussionmentioning

confidence: 65%

“… 1 , 8 , 9 , 10 There were anecdotal reports of MIS‐C presenting with prominent cervical manifestations. 11 , 12 , 13 , 14 …”

Section: Introductionmentioning

confidence: 99%

Multisystem inflammatory syndrome in children associated with COVID‐19 presenting as cervical inflammation

et al. 2022

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Aim The major clinical manifestations multisystem inflammatory syndrome in children (MIS‐C) are fever, gastrointestinal and cardiac. The aim of this study was to describe MIS‐C in a series of patients who presented primarily with cervical manifestations. Methods We retrospectively reviewed medical records of all patients who met the Centers for Disease Control and Prevention and World Health Organization MIS‐C diagnostic criteria treated at Hadassah‐Hebrew University Medical Center between April 2020 and September 2021. Results Of 37 children diagnosed with MIS‐C (median age: 10.2 years, range 1.5–18 years, 20 male) five, 13.5% (median age: 14.4 years, range 9.2–17.5 years) presented with cervical symptoms mimicking neck infections. One was hospitalised with a working diagnosis of retropharyngeal abscess, and four with acute cervical lymphadenitis that did not respond to early antibiotic treatment. All developed full MIS‐C phenotype. Conclusion MIS‐C may present as cervical inflammation. An ill‐appearing child with symptoms and/or signs of cervical inflammation should be evaluated for clinical and laboratory features of MIS‐C, thereby facilitating prompt treatment of this potentially fatal disorder.

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“…Some researchers consider that the retropharyngeal abnormalities in KD are presumably linked to the vasculitis of microvessels that cause oedema and in ammation, which is a non-infectious in ammatory reaction. [11][12][13] But some researchers consider that the infection of some bacteria such as staphylococcal and streptococcal toxin as superantigens may be involvement in the pathogenesis of KD.…”

Section: Discussionmentioning

confidence: 99%

Incomplete Kawasaki disease with a retropharyngeal space abscess as the main manifestation

CHEN

Yang

2022

Preprint

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Background: Kawasaki disease (KD) is a childhood acute self-limiting systemic vasculitis of unknown etiology. The diagnosis of KD is based upon clinician's recognition of a symptom pattern. However, manifestations of KD can be atypical, Deep neck infections (DNIs) is a rare manifestation of KD, which can mislead the clinician and delay diagnosis. The following case report describes a patient with incomplete Kawasaki disease (iKD) whose initial presentation a retropharyngeal abscess.Case presentation: A child with clinical manifestations of fever, neck pain, cervical lymphadenopathy, high erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) was reported. The anti-infective treatment was not effective. A retropharyngeal space abscess was detected on neck enhanced Computed Tomography (CT). On the third day following admission, the conjunctival hyperemia, red lips, and strawberry tongue appeared gradually. High-dose of intravenous immunoglobulins (IVIG) and oral aspirin were administered with rapid defervescence, fever and neck pain gradually disappeared, and the neck Magnetic Resonance Imaging (MRI) showed that the abscess was completely resolved.Conclusion: KD with a retropharyngeal space abscess as the first manifestation is rare and may be related to Streptococcus or Staphylococcus aureus infection. When anti-infective treatment was not effective, it is very important to provide timely diagnosis and treatment in combination with other clinical features of KD.

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Pediatric inflammatory multisystem syndrome (PIMS) presenting with retropharyngeal phlegmon mimicking Kawasaki disease

Cited by 11 publications

References 5 publications

Retropharyngeal involvement in multisystem inflammatory syndrome in children: Case report and review of literature

Retropharyngeal involvement in multisystem inflammatory syndrome in children: Case report and review of literature

Multisystem inflammatory syndrome in children associated with COVID‐19 presenting as cervical inflammation

Incomplete Kawasaki disease with a retropharyngeal space abscess as the main manifestation

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