Acute peritonsillar swelling: a unique presentation for Kawasaki disease in adolescence

Abstract

We report the case of a 14-year-old man with unilateral peritonsillar swelling, airway compromise and fever. On physical examination, the patient was pyrexic with trismus, dysphonia, uvula deviation, exudative unilateral peritonsillar swelling and unilateral cervical lymphadenopathy. Attempts at aspirating the prominent peritonsillar region were unsuccessful. CT head and neck identified a large inflammatory mass arising from the left palatine tonsil. The patient was treated for presumptive peritonsillar abscess. After failing to respond to intravenous antimicrobials, he progressively developed the classical sequale of Kawasaki's Disease. Echocardiogram identified coronary arteritis. Intravenous immunoglobulin and high-dose aspirin were initiated and his clinical picture improved. Kawasaki's disease mimicking an acute infective process can pose a diagnostic dilemma. It is an uncommon differential in the adolescent population. Prompt recognition and initiation of appropriate therapy are imperative to minimise morbidity.

Retropharyngeal abscess-like as an atypical presentation of Kawasaki disease: a case report and literature review

“…Peritonsillar, retropharyngeal and parapharyngeal swelling are uncommonly reported as initial manifestations of KD. The precise pathophysiology of the association of KD with retroparapharyngeal pathology is unclear, with inflammation and edema hypothesized as the main mechanisms [ 3 , 8 ].…”

“…The vasculitis predominantly affects medium-sized arteries, with a striking predilection for the coronary arteries, leading to coronary artery aneurysms (CAAs) in 15- 25% of untreated cases, and thus causing the most important life-threatening complication of KD [ 1 – 4 ]. KD is the major cause of acquired heart disease in the developed world, with consequences including myocardial infarction, ischemic heart disease, and sudden death [ 1 , 3 , 5 , 6 ].…”

Kawasaki disease with peritonsillar abscess as the first symptom: A case report

“…Cai et al [ 25 ] reported a 3-year-old child with parapharyngeal swelling secondary to KD who underwent parapharyngeal abscess incision and drainage on day 3 of admission, and for whom KD was diagnosed on day 8 of admission, with the symptoms resolving after treatment with aspirin and intravenous gammaglobulin. A 14-year-old male was initially diagnosed with a peri-tonsillar abscess, and the patient presented with clinical manifestations typical of KD before surgical treatment was performed[ 26 ]. All of these cases which initially lacked the typical clinical manifestations of KD, were typically treated with local surgery.…”