Kim N, Choi YJ, Na JY, Oh JW. Lymph-node-first presentation of Kawasaki disease in a 12-year-old girl with cervical lymphadenitis caused by Mycoplasma pneumoniae: A case report. World J Clin Cases 2022; 10(10): 3170-3177 [PMID: 35611136 DOI: 10.12998/wjcc.v10.i10.3170]
Corresponding Author of This Article
Young-Jin Choi, MD, PhD, Assistant Professor, Department of Pediatrics, Hanyang University Guri Hospital, Gyeongchun-ro 153, Guri-si 11923, South Korea. pg0311@hanmail.net
Research Domain of This Article
Pediatrics
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Apr 6, 2022; 10(10): 3170-3177 Published online Apr 6, 2022. doi: 10.12998/wjcc.v10.i10.3170
Lymph-node-first presentation of Kawasaki disease in a 12-year-old girl with cervical lymphadenitis caused by Mycoplasma pneumoniae: A case report
Nayoung Kim, Young-Jin Choi, Jae Yoon Na, Jae-Won Oh
Nayoung Kim, Jae Yoon Na, Department of Pediatrics, Hanyang University Seoul Hospital, Seoul 04763, South Korea
Young-Jin Choi, Department of Pediatrics, Hanyang University Guri Hospital, Guri-si 11923, South Korea
Jae-Won Oh, Department of Pediatrics, Hanyang University School of Medicine, Seoul 04763, South Korea
Author contributions: Choi YJ, Na JY, and Kim N planned and designed the study; Choi YJ and Kim N wrote the main manuscript text and prepared the figures; Choi YJ, Na JY, and Oh JW revised the manuscript.
Informed consent statement: We obtained parental consent for this case report.
Conflict-of-interest statement: The authors declare no conflict of interests for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Young-Jin Choi, MD, PhD, Assistant Professor, Department of Pediatrics, Hanyang University Guri Hospital, Gyeongchun-ro 153, Guri-si 11923, South Korea. pg0311@hanmail.net
Received: July 17, 2021 Peer-review started: July 17, 2021 First decision: November 11, 2021 Revised: November 12, 2021 Accepted: February 22, 2022 Article in press: February 22, 2022 Published online: April 6, 2022
Abstract
BACKGROUND
To the best of our knowledge, cases of Kawasaki disease (KD) occurring at the age of 12 are rare, even in Asia where the incidence of KD is high. We report a case of lymph-node-first presentation of KD (NFKD) in a 12-year-old girl with Mycoplasma pneumoniae (M. pneumoniae) infection who presented with prolonged fever and lymphadenitis refractory to macrolide antibiotics.
CASE SUMMARY
A previously healthy 12-year-old girl presented with fever, myalgia, sore throat, swelling, and tenderness on the right side of the neck. She was initially diagnosed with lymphadenitis caused by M. pneumoniae refractory to macrolide antibiotics. She had elevated brain natriuretic peptide (BNP) levels. Finally, the patient was diagnosed with KD. After receiving intravenous immunoglobulin, the fever resolved, and her symptoms improved.
CONCLUSION
NFKD should be differentiated from adolescent lymphadenitis presenting with prolonged fever by checking the BNP level early.
Core Tip: We report the case of a 12-year-old girl with lymphadenitis caused by Mycoplasma pneumoniae refractory to macrolide antibiotics. The fever persisted, and the patient did not respond to macrolide (clarithromycin) administered for 72 h. The brain natriuretic peptide (BNP) level, additionally measured to diagnose atypical Kawasaki disease (KD), was 427.2 ng/mL. A slight QT interval prolongation and a dilated right coronary artery were detected. She was finally diagnosed with lymph-node-first presentation of KD. Even if adolescent lymphadenitis with confirmed bacterial or viral infection does not have other symptoms of KD, early measurement of BNP levels can help diagnose KD.
