Retropharyngeal abscess: An unusual presentation of Kawasaki disease. Case report and review of the literature

Cavicchiolo, Maria Elena; Berlese, Paola; Bressan, Silvia; Trincia, Elena; Inches, Ingrid; Strafella, Maria Stefania; Stefani, Chiara; Dalt, Liviana Da

doi:10.1016/j.pedex.2012.09.002

Cited by 6 publications

(4 citation statements)

References 14 publications

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“…The otolaryngological presentation of KD remains quite frequent and may divert physicians in pursuing other relevant diagnoses causing significant delay in the initiation of treatment of KD [8][9][10][11][12]. According to a literature review by Cavicchiolo et al [13], of 16 reported cases of atypical KD with retropharyngeal abscess, most of the cases were of males, with a shorter duration of fever upon presentation (<4 days) and signs of deep neck infections. Furthermore, they failed to respond to broad-spectrum IV antibiotics and no tissue fluctuance or purulent fluid collection was found among all those who underwent surgical exploration of the retropharyngeal space [13].…”

Section: Discussionmentioning

confidence: 99%

“…According to a literature review by Cavicchiolo et al [13], of 16 reported cases of atypical KD with retropharyngeal abscess, most of the cases were of males, with a shorter duration of fever upon presentation (<4 days) and signs of deep neck infections. Furthermore, they failed to respond to broad-spectrum IV antibiotics and no tissue fluctuance or purulent fluid collection was found among all those who underwent surgical exploration of the retropharyngeal space [13]. These findings are in conjunction with our case.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Rethinking the Typical Diagnostic and Therapeutic Challenges of Kawasaki Disease

Mazahir

Saqqa²,

Magzoub³

et al. 2022

Dubai Med J

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This report presents a case of a 9-month-old male subject, with an initial presentation of a viral-like illness progressing rapidly to multiple deep neck abscesses involving the bilateral submandibular, parapharyngeal, retropharyngeal, and anterior mediastinal spaces subsequently confirmed with contrast-enhanced computed tomography of the neck. Additionally, the subject developed mucocutaneous signs of generalized erythematous rash, with red, fissured lips along with edema of the extremities. Initial lab parameters were suggestive of high inflammatory markers, low albumin, and deranged coagulation profile. Treatment with broad-spectrum intravenous antibiotics, albumin, and fresh frozen plasma infusions was commenced. Echocardiography revealed dilatation of the left main coronary artery with mild mitral valvular regurgitation. Based on the clinical criteria, a diagnosis of typical Kawasaki disease (KD) on day 5 of illness was made, and the subject received intravenous immunoglobulin (IVIg) and aspirin. The clinical course was complicated by IVIg resistance, for which a second dose of IVIg and pulse systemic corticosteroid therapy was required. Post defervescence, an isolated elevation of activated thromboplastin time, partially corrected with mixing studies and a positive circulating lupus anticoagulant was noted. The patient did not develop any bleeding or thromboembolic complications during his hospital stay. Surgical drainage of the neck abscesses did not yield any pus or fluid collection. After a stormy course of 31 days, the subject was discharged with an improving trend of inflammatory markers and no progression of coronary artery dilatation. Gradual resolution to baseline health was noted upon follow-up, 18 months postdischarge from the hospital. Despite being one of the most common cause of childhood acquired cardiac disease, KD still poses a significant diagnostic and treatment challenge to physicians. This requires physicians to be vigilant for timely diagnosis and appropriate management to prevent significant cardiac comorbidities and be aware of the possible complications that might arise during the treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Rethinking the Typical Diagnostic and Therapeutic Challenges of Kawasaki Disease

Mazahir

Saqqa²,

Magzoub³

et al. 2022

Dubai Med J

View full text Add to dashboard Cite

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“…Additional features of KD appeared gradually during hospitalization. 6 , 7 After carefully comparing children with KD accompanied by retropharyngeal edema to, those with RPA, Nomura et al 6 concluded that close attention to core manifestations but not laboratory examinations of KD helps clinicians to differentiate these 2 conditions. Obviously, our findings agree with Nomura's report.…”

Section: Discussionmentioning

confidence: 99%

Kawasaki Disease Mimicking a Parapharyngeal Abscess

et al. 2015

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Parapharyngeal abscess (PPA)-like lesion is a very rare manifestation of Kawasaki disease (KD). Here we report a Chinese case of KD initially mimicking PPA, which is the first one reported in Asia.A 3-year-old male patient presented with fever, drooling, and bilateral painful cervical lymphadenopathy for 3 days. Chest X-ray and echocardiogram were normal. With substantial elevation of white blood count and C-reactive protein, purulent cervical lymphadenitis was considered. Symptoms did not improve after treatment with vancomycin, and the patient further developed trismus and restricted neck movement. Neck CT revealed a 2 × 1.5 cm hypodense lesion in the right parapharyngeal space with peripheral enhancement. PPA was suspected and on the 3rd day following admission, the patient received surgical incision and drainage. One milliliter of serous fluid was drained without bacterial growth on cultures. Fever persisted after surgery. As the clinical course proceeded, additional major signs of KD gradually evolved, and on the 6th day following admission the patient completely fulfilled the diagnostic criteria for KD. Rapid clinical improvement was observed following treatment with high-dose immunoglobulin and aspirin. Due to the parapharyngeal operation, the patient was fed milk through a nasogastric tube for 15 days. His neck incision became infected but healed gradually following dressing change and antibiotic treatment. Currently he remains asymptomatic during regular follow-up and repeated echocardiograms are normal.Both pediatricians and otolaryngologists can learn from this case that KD may initially manifest as PPA. Careful observation for major signs of KD during the clinical course can help to achieve a prompt and correct diagnosis. Thus, unnecessary surgery and cardiac complications of KD may be avoided.

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“…Although the precise pathophysiology of retropharyngeal edema in KD is unclear, clinical findings, operative details, sterile culture results, and the responses to intravenous immunoglobulin treatment suggest that the mechanism is an intense inflammatory response [ 18 ]. Because most patients with KD and retropharyngeal edema are initially misdiagnosed as having a retropharyngeal abscess, such patients frequently have a delayed diagnosis of KD and undergo unnecessary antibiotic treatment and/or pharyngeal aspiration [ 19 ]. Nomura et al [ 20 ] recently reported that clinical symptoms of dysphagia and neck pain and neck CT findings, including a ring enhancement and mass effect of retropharyngeal lesions, occurred significantly more frequently in patients with retropharyngeal abscesses than in KD patients with retropharyngeal edema.…”

Section: Discussionmentioning

confidence: 99%

Kawasaki Disease with Retropharyngeal Edema following a Blackfly Bite

Watanabe

2014

Case Reports in Pediatrics

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We describe a patient with Kawasaki disease (KD) and retropharyngeal edema following a blackfly bite. An 8-year-old boy was referred to our hospital because of a 3-day-history of fever and left neck swelling and redness after a blackfly bite. Computed tomography of the neck revealed left cervical lymph nodes swelling with edema, increased density of the adjacent subcutaneous tissue layer, and low density of the retropharyngeum. The patient was initially presumed to have cervical cellulitis, lymphadenitis, and retropharyngeal abscess. He was administered antibiotics intravenously, which did not improve his condition. The patient subsequently exhibited other signs of KD and was diagnosed with KD and retropharyngeal edema. Intravenous immunoglobulin therapy and oral flurbiprofen completely resolved the symptoms and signs. A blackfly bite sometimes incites a systemic reaction in humans due to a hypersensitive reaction to salivary secretions, which may have contributed to the development of KD in our patient.

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Retropharyngeal abscess: An unusual presentation of Kawasaki disease. Case report and review of the literature

Cited by 6 publications

References 14 publications

Rethinking the Typical Diagnostic and Therapeutic Challenges of Kawasaki Disease

Rethinking the Typical Diagnostic and Therapeutic Challenges of Kawasaki Disease

Kawasaki Disease Mimicking a Parapharyngeal Abscess

Kawasaki Disease with Retropharyngeal Edema following a Blackfly Bite

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