Incomplete Kawasaki disease presenting as a para-pharyngeal abscess-like lesion: a case report

Abstract

Background: Kawasaki disease (KD) is an acute, self-limited febrile illness of unknown cause, that predominantly affects children < 5 years of age. The diagnosis is merely clinic, based on the identification of principal clinical findings and the exclusion of other clinically similar entities. Patients who do not fulfill the complete diagnostic criteria for KD are referred to as incomplete form. Lymphadenopathy is the least common symptom in patients with KD. The rate of cervical lymphadenopathy occurring as the initial presenting symptom is only approximately 12%. As a result, KD could be initially diagnosed as bacterial lymphadenitis and treated improperly with antibiotics.Case presentation: we describe the case of a 5 years-old girl of African origin presented to our emergency department with a two-day history of fever and left unilateral lymph node swelling. Persistent fever, unresponsiveness to broad-spectrum antibiotics therapy, the evidence on computerized-tomography (CT) scan of para-pharyngeal abscesses-like lesion and the onset of other characteristic clinical features that emerged gradually, provided support for a diagnosis of incomplete KD. The excellent response within 24 hours after administration of intravenous immunoglobulin (IVIG) and the rapid resolution of fever, confirmed the correct diagnosis of incomplete KD.Conclusions: from this case we need to realize that para-pharyngeal involvement with edema, cellulitis and abscess-like lesions is a rare, but possible initial manifestation of KD. To avoid delayed diagnosis, clinicians have to be alert to identifying head and neck manifestations as a possible early presentation of KD and include it as a routine differential diagnosis for suspected parapharyngeal abscesses.