Huo LM, Li LM, Peng HY, Wang LJ, Feng ZY. Kawasaki disease with peritonsillar abscess as the first symptom: A case report. World J Clin Cases 2023; 11(22): 5391-5397 [PMID: 37621581 DOI: 10.12998/wjcc.v11.i22.5391]
Corresponding Author of This Article
Zhang-Ying Feng, PhD, Chief Pharmacist, Department of Clinical Pharmacology, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Road, Chang’an District, Shijiazhuang 050011, Hebei Province, China. fengzhangying@126.com
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/
Li-Man Huo, Department of Pharmacy, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
Li-Min Li, Department of Paediatrics, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
Hao-Yang Peng, Department of Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
Li-Jia Wang, Department of Medical Imaging, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
Zhang-Ying Feng, Department of Clinical Pharmacology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
Author contributions: Feng ZY conceived of the study and revised manuscript; Huo LM and Li LM collected the data and wrote the manuscript; Peng HY and Wang LJ analyzed the corresponding ultrasound and CT results and wrote the manuscript.
Informed consent statement: Written informed consent was obtained from the patient's parent for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
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: Zhang-Ying Feng, PhD, Chief Pharmacist, Department of Clinical Pharmacology, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Road, Chang’an District, Shijiazhuang 050011, Hebei Province, China. fengzhangying@126.com
Received: May 21, 2023 Peer-review started: May 21, 2023 First decision: June 13, 2023 Revised: June 25, 2023 Accepted: July 17, 2023 Article in press: July 17, 2023 Published online: August 6, 2023
Abstract
BACKGROUND
Kawasaki disease (KD), also known as mucocutaneous lymph node syndrome, is an acute, self-limiting vasculitis of unknown aetiology that mainly involves the medium and small arteries and can lead to serious cardiovascular complications, with a 25% incidence of coronary artery aneurysms. Periton–Sillar abscesses are a rare symptom of KD and is easily misdiagnosed at its early stages.
CASE SUMMARY
A 5-year-old boy who presented to a community hospital with a 3-d fever, difficulty in opening his mouth, and neck pain and was originally treated for throat infection without improvement. On the basis of laboratory tests, ultrasound of submandibular and superficial lymph nodes and computed tomography of the neck, the clinician diagnosed the periamygdala abscess and sepsis that did not resolve after antibiotic therapy. On the fifth day of admission, the child developed conjunctival congestion, prune tongue, perianal congestion and desquamation, and slightly stiff and swollen bunions on both feet. A diagnosis of KD was reached with complete remission after intravenous immunoglobulin treatment.
CONCLUSION
Children with neck pain, lymph node enlargement, or airway obstruction as the main manifestations are poorly treated with intravenous broad-spectrum antibiotics. Clinicians should not rush invasive operations such as neck puncture, incision, and drainage and should be alert for KD when it cannot be explained by deep neck space infection and early treatment with aspirin combined with gammaglobulin.
Core Tip: Some typical symptoms of a suppurative infection of the deep neck fever, for example elevated white blood cell count, lymph node enlargement, and abnormal changes in the head and neck, may also be atypical manifestations of Kawasaki disease (KD). For cases with a long course of fever and no response to antibiotic treatment, careful observation of symptoms, signs, and cervical imaging findings in the progression of the disease can be used to detect KD with deep neck changes as the first symptom early and avoid the occurrence of serious complications.
