Cai Qianyun, Luo Rong, Gan Jing, Zhang Li, Qu Yi, Mu Dezhi
From the Department of Pediatrics, West China Second University Hospital, Sichuan University (QC, RL, JG, LZ, YQ, DM); and Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu 610041, Sichuan, China (YQ, DM).
Medicine (Baltimore). 2015 May;94(17):e761. doi: 10.1097/MD.0000000000000761.
Parapharyngeal abscess (PPA)-like lesion is a very rare manifestation of Kawasaki disease (KD). Here we report a Chinese case of KD initially mimicking PPA, which is the first one reported in Asia.A 3-year-old male patient presented with fever, drooling, and bilateral painful cervical lymphadenopathy for 3 days. Chest X-ray and echocardiogram were normal. With substantial elevation of white blood count and C-reactive protein, purulent cervical lymphadenitis was considered. Symptoms did not improve after treatment with vancomycin, and the patient further developed trismus and restricted neck movement. Neck CT revealed a 2 × 1.5 cm hypodense lesion in the right parapharyngeal space with peripheral enhancement. PPA was suspected and on the 3rd day following admission, the patient received surgical incision and drainage. One milliliter of serous fluid was drained without bacterial growth on cultures. Fever persisted after surgery. As the clinical course proceeded, additional major signs of KD gradually evolved, and on the 6th day following admission the patient completely fulfilled the diagnostic criteria for KD. Rapid clinical improvement was observed following treatment with high-dose immunoglobulin and aspirin. Due to the parapharyngeal operation, the patient was fed milk through a nasogastric tube for 15 days. His neck incision became infected but healed gradually following dressing change and antibiotic treatment. Currently he remains asymptomatic during regular follow-up and repeated echocardiograms are normal.Both pediatricians and otolaryngologists can learn from this case that KD may initially manifest as PPA. Careful observation for major signs of KD during the clinical course can help to achieve a prompt and correct diagnosis. Thus, unnecessary surgery and cardiac complications of KD may be avoided.
咽旁间隙脓肿（PPA）样病变是川崎病（KD）非常罕见的一种表现形式。在此，我们报告一例最初疑似PPA的中国KD病例，这是亚洲首例报告的此类病例。一名3岁男性患者出现发热、流口水及双侧颈部疼痛性淋巴结肿大3天。胸部X线和超声心动图检查正常。由于白细胞计数和C反应蛋白大幅升高，考虑为化脓性颈部淋巴结炎。使用万古霉素治疗后症状未改善，患者进一步出现牙关紧闭和颈部活动受限。颈部CT显示右侧咽旁间隙有一个2×1.5 cm的低密度病变，周边强化。怀疑为PPA，入院第3天患者接受了手术切开引流。引出1毫升浆液性液体，培养无细菌生长。术后发热持续。随着临床病程进展，KD的其他主要体征逐渐出现，入院第6天患者完全符合KD诊断标准。使用大剂量免疫球蛋白和阿司匹林治疗后观察到临床症状迅速改善。由于咽旁手术，患者通过鼻胃管喂牛奶15天。他的颈部切口感染，但经换药和抗生素治疗后逐渐愈合。目前在定期随访中他无症状，多次超声心动图检查均正常。儿科医生和耳鼻喉科医生均可从此病例中了解到，KD最初可能表现为PPA。临床过程中仔细观察KD的主要体征有助于及时做出正确诊断。因此，可以避免不必要的手术及KD的心脏并发症。
