Fang Li-Ching, Shyur Shyh-Dar, Peng Chun-Chih, Jim Wai-Tim, Chu Szu-Hung, Kao Yu-Hsuan, Chen Chen-Kuan, Liu Ling-Chun
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
J Microbiol Immunol Infect. 2014 Apr;47(2):152-7. doi: 10.1016/j.jmii.2012.01.017. Epub 2012 Apr 12.
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.
我们报告一名3岁患有川崎病的女童，她出现了咽后水肿和休克综合征。这是台湾地区首例报告病例。该患者最初表现为发热、咳嗽和脓尿，随后双侧颈部淋巴结迅速进行性肿大。发热第三天，计算机断层扫描检查气道压迫征象时发现咽后间隙增宽，类似咽后脓肿。后来，因呼吸窘迫插入了气管插管。还注意到她躯干上有皮疹。发热第五天，临床病程进展为低血压和休克综合征。由于双侧颈部淋巴结肿胀加剧，再次安排计算机断层扫描，结果显示咽后间隙水肿改变部分消退。随后发现手足水肿、双侧球结膜充血和嘴唇皲裂。发热第八天确诊为川崎病。没有细菌感染的证据。给予她静脉注射免疫球蛋白（2mg/kg）和高剂量阿司匹林（100mg/kg/天）。一天后，发热消退，血压逐渐稳定。第13天的心脏超声心动图显示左冠状动脉扩张和二尖瓣反流。六个月后的随访超声心动图显示冠状动脉正常。迄今为止，该患者未出现任何并发症。本病例表明，咽后水肿和休克综合征可出现在川崎病的同一临床病程中。临床医生和重症监护病房工作人员应注意川崎病的不寻常表现，以降低心血管并发症的发生率。
