Liu Tzu Ning, Kuplicki Abigail C, Ang Jocelyn Y
Wayne State University School of Medicine, Detroit, MI, USA.
Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA.
Glob Pediatr Health. 2023 Jun 15;10:2333794X231180420. doi: 10.1177/2333794X231180420. eCollection 2023.
Cervical lymphadenopathy is seldom the initial symptom of Kawasaki disease (KD), making diagnosis difficult in early node-first Kawasaki disease (NFKD). Early treatment is important to prevent cardiovascular sequelae. This report discusses a case of a 4-year-old African American female with NFKD and retropharyngeal phlegmon who was initially treated with antibiotics for cervical lymphadenitis. She later developed classic symptoms of KD, including mucositis, conjunctivitis, palmar erythema, and truncal rash. KD was then suspected and treated appropriately, with the patient experiencing rapid clinical improvement. Early misdiagnosis of NFKD is not uncommon, but certain indices, such as patient age, elevated absolute neutrophil count, or elevated liver enzymes, may be helpful in increasing clinical suspicion. NFKD and retropharyngeal phlegmon remain a rare presentation of an already known condition. The case presented here emphasizes the need for KD to be a differential diagnosis in cases of cervical lymphadenitis and retropharyngeal abscess refractory to antibiotic treatment.
颈部淋巴结病很少是川崎病（KD）的初始症状，这使得早期以淋巴结肿大为首发症状的川崎病（NFKD）的诊断变得困难。早期治疗对于预防心血管后遗症很重要。本报告讨论了一例4岁非裔美国女性患NFKD并伴有咽后蜂窝织炎的病例，该患者最初因颈部淋巴结炎接受抗生素治疗。她后来出现了KD的典型症状，包括口腔黏膜炎症、结膜炎、手掌红斑和躯干皮疹。随后怀疑为KD并进行了适当治疗，患者临床症状迅速改善。NFKD的早期误诊并不罕见，但某些指标，如患者年龄、绝对中性粒细胞计数升高或肝酶升高，可能有助于提高临床怀疑度。NFKD和咽后蜂窝织炎仍然是一种已知疾病的罕见表现。此处呈现的病例强调了在颈部淋巴结炎和抗生素治疗无效的咽后脓肿病例中，KD作为鉴别诊断的必要性。
