Retropharyngeal Edema: An Unusual Manifestation of Kawasaki Disease

Langley, Emily W.; Kirse, Daniel K.; Barnes, Craig E.; Covitz, Wesley; Shetty, Avinash K.

doi:10.1016/j.jemermed.2008.08.004

Cited by 37 publications

(47 citation statements)

References 14 publications

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“…We firstly described atypical presentation of KD in infant patients. Although the underlying exact pathophysiological cause of developing retropharyngeal low-attenuation area is not clearly known, it has been postulated that such findings may be related to intense inflammatory response mechanism in KD patients [9]. The clinical, CT, surgical, and echocardiogram findings of previous cases including our cases are summarized in Table 1.…”

Section: Discussionmentioning

confidence: 85%

“…However, we believe that the true incidence of atypical retropharyngeal abscess-like lesion is most likely underestimated because CT of neck is not routinely obtained in all patients diagnosed with KD. So far, there have been at least 11 reported cases of KD patients who initially presented with retropharyngeal low attenuation, and all of them were more than 1.5 years of age [1,[3][4][5][6][7][8][9][10]. We firstly described atypical presentation of KD in infant patients.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2011

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

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

et al. 2011

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“…The precise pathophysiology of the association of KD with retropharyngeal pathology is unclear. 11 However, inflammation and edema were considered the main mechanism. 19 Increased microvascular permeability is an initial step of KD, and vascular endothelial growth factor might play a role in the vascular leakage.…”

Section: Discussionmentioning

confidence: 99%

“…8 There are some reports of patients with KD who underwent surgical exploration in retropharyngeal areas, but cultures of the inflammatory material were sterile in all cases. 8,11,28 To date, no study has reported KD accompanied with a proven retropharyngeal abscess. 11 Therefore, we hypothesize that the retropharyngeal space widening and edematous change were presentations of inflammation in KD.…”

Section: Discussionmentioning

confidence: 99%

Unusual manifestations of Kawasaki disease with retropharyngeal edema and shock syndrome in a Taiwanese child

Fang

Shyur

Peng

et al. 2014

Journal of Microbiology, Immunology and Infection

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We report a 3-year-old girl with Kawasaki disease who presented with retropharyngeal edema and shock syndrome. This is the first reported case in Taiwan. The patient initially presented with fever, cough, and pyuria followed by rapidly progressive enlarged bilateral cervical lymphadenopathy. On the third day of the fever, computed tomography for airway compression sign found widening of the retropharyngeal space mimicking a retropharyngeal abscess. Later, an endotracheal tube was inserted for respiratory distress. A skin rash over her trunk was also noted. On the fifth day of the fever, the clinical course progressed to hypotension and shock syndrome. Because of more swelling of bilateral neck lymph nodes, computed tomography was arranged again and revealed partial resolution of the edematous changes in the retropharyngeal space. Edema of the hands and feet, bilateral bulbar conjunctivitis, and fissured lips were subsequently found. The diagnosis of Kawasaki disease was confirmed on the eighth day of fever. There was no evidence of bacterial infection. She was administered intravenous immunoglobulin (2 mg/kg) and high dose aspirin (100 mg/kg/day). One day later, the fever subsided, and her blood pressure gradually became stable. Heart echocardiography on the Day 13 revealed dilated left coronary artery and mitral regurgitation. Follow-up echocardiography six months later showed normal coronary arteries. To date, the patient has not experienced any complications. This case illustrates that retropharyngeal edema and shock syndrome can be present in the same clinical course of Kawasaki disease. Clinicians and those who work in intensive care units should be aware of unusual presentations of Kawasaki disease to decrease rates of cardiovascular complications.

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“…66 Atypical presentations, such as retropharyngeal edema, pseudointestinal obstruction, cholestasis with jaundice, pleural effusion, and hematuria can also lead to diagnostic challenges. [67][68][69][70][71][72] The rate of coronary artery involvement in incomplete and atypical cases is the same as in the full-blown syndrome. 73 No specific laboratory test for KD exists, but DNA microarray technology may identify increased expression of genes specifically associated with the condition.…”

Section: Toxic Shock Syndromeerelated Syndromesmentioning

confidence: 99%