DOI QR코드

DOI QR Code

Kawasaki Disease with Fever and Cervical Lymphadenopathy as the Sole Initial Presentation

  • Jun, Woo Young (Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Ann, Yu Kyung (Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Kim, Ja Yeong (Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Son, Jae Sung (Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Kim, Soo-Jin (Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Yang, Hyun Suk (Department of Cardiovascular Medicine, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Bae, Sun Hwan (Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Chung, Sochung (Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Kim, Kyo Sun (Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine)
  • Received : 2016.04.21
  • Accepted : 2016.07.05
  • Published : 2017.01.31

Abstract

Background and Objectives: Some patients with Kawasaki disease (KD) present with fever and cervical lymphadenopathy alone. The purpose of this study was to characterize the clinical features of these unusual KD patients and determine whether this is a severe form of KD associated with increased risks of intravenous immunoglobulin (IVIG) resistance and coronary artery lesions (CALs). Subjects and Methods: A total of 146 children with KD were reviewed retrospectively, and classified into two groups according to initial clinical features. Those presenting with only fever and cervical lymphadenopathy (LKD) were classified as LKD patients. Other-KD patients included all except the LKD patients. Results: Among 146 KD patients, 13 (8.9%) were classified as LKD patients. The LKD patients were significantly older and admitted earlier. The duration between fever onset and KD diagnosis was significantly longer in the LKD patients (5.9 days vs. 4.9 days, p=0.023). The frequency of IVIG resistance was not different between the two groups., In the LKD patients, the incidence of CALs was significantly higher in the acute phase, and without significant difference in the convalescent phase. The percentage of neutrophils and C-reactive protein, albumin, and total bilirubin levels were significantly higher in LKD patients. Conclusion: Even though LKD patients were older, admitted earlier, and had higher inflammatory marker levels, they did not have a greater risk of CALs or IVIG resistance. However, echocardiography may be helpful in the acute stage if patients have only fever and cervical lymphadenopathy and are unresponsive to empirical antibiotics.

Keywords

Acknowledgement

Supported by : Konkuk University

References

  1. Kawasaki T. Acute febrile lymph node syndrome: Clinical observations of 50 cases. Jpn J Allergy 1967;16:178-222.
  2. Newburger JW, Takahashi M, Gerber MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Pediatrics 2004;114:1708-33. https://doi.org/10.1542/peds.2004-2182
  3. Yanagi S, Nomura Y, Masuda K, et al. Early diagnosis of Kawasaki disease in patients with cervical lymphadenopathy. Pediatr Int 2008;50:179-83. https://doi.org/10.1111/j.1442-200X.2008.02547.x
  4. Eleftheriou D, Levin M, Shingadia D, Tulloh R, Klein NJ, Brogan PA. Management of Kawasaki disease. Arch Dis Child 2014;99:74-83. https://doi.org/10.1136/archdischild-2012-302841
  5. Kanegaye JT, Van Cott E, Tremoulet AH, et al. Lymph-node-first presentation of Kawasaki disease compared with bacterial cervical adenitis and typical Kawasaki disease. J Pediatr 2013:162:1259-63, 1263.e1-2.
  6. Kubota M, Usami I, Yamakawa M, Tomita Y, Haruta T.Kawasaki disease with lymphadenopathy and fever as sole initial manifestations. J Paediatr Child Health 2008;44:359-62. https://doi.org/10.1111/j.1440-1754.2008.01310.x
  7. Kao HT, Huang YC, Lin TY. Kawasaki disease presenting as cervical lymphadenitis or deep neck infection. Otolaryngol Head Neck Surg 2001;124:468-70. https://doi.org/10.1067/mhn.2001.114796
  8. Park AH, Batchra N, Rowley A, Hotaling A. Patterns of Kawasaki syndrome presentation. Int J Pediatr Otorhinolaryngol 1997;40:41-50. https://doi.org/10.1016/S0165-5876(97)01494-8
  9. Nomura Y, Arata M, Koriyama C, et al. A severe form of Kawasaki disease presenting with only fever and cervical lymphadenopathy at admission. J Pediatr 2010;156:786-91. https://doi.org/10.1016/j.jpeds.2009.11.042
  10. April MM, Burns JC, Newburger JW, Healy GB. Kawasaki disease and cervical adenopathy. Arch Otolaryngol Head Neck Surg 1989;115:512-4. https://doi.org/10.1001/archotol.1989.01860280110027
  11. Stamos JK, Corydon K, Donaldson J, Shulman ST. Lymphadenitis as the dominant manifestation of Kawasaki disease. Pediatrics 1994;93:525-8.
  12. Research Committee on Kawasaki Disease. Report of subcommittee on standardization of diagnostic criteria and reporting of coronary artery lesions in Kawasaki disease. Tokyo: Japanese Ministry of Health and Welfare; 1984. p.56-66
  13. Kobayashi T, Inoue Y, Takeuchi K, et al. Prediction of intravenous immunoglobulin unresponsiveness in patients with Kawasaki disease. Circulation 2006;113:2606-12. https://doi.org/10.1161/CIRCULATIONAHA.105.592865
  14. Egami K, Muta H, Ishii M, et al. Prediction of resistance to intravenous immunoglobulin treatment in patients with Kawasaki disease. J Pediatr 2006;149:237-40. https://doi.org/10.1016/j.jpeds.2006.03.050
  15. Sano T, Kurotobi S, Matsuzaki K, et al. Prediction of nonresponsiveness to standard high-dose gamma-globulin therapy in patients with acute Kawasaki disease before starting initial treatment. Eur J Pediatr 2007;166:131-7.
  16. Eladawy M, Dominguez SR, Anderson MS, Glode MP. Abnormal liver panel in acute kawasaki disease. Pediatr Infect Dis J 2011;30:141-4. https://doi.org/10.1097/INF.0b013e3181f6fe2a
  17. Kobayashi T, Saji T, Otani T, et al. Efficacy of immunoglobulin plus prednisolone for prevention of coronary artery abnormalities in severe Kawasaki disease (RAISE study): a randomised, open-label, blinded-endpoints trial. Lancet 2012;379:1613-20. https://doi.org/10.1016/S0140-6736(11)61930-2
  18. Muta H, Ishii M, Yashiro M, Uehara R, Nakamura Y. Late intravenous immunoglobulin treatment in patients with Kawasaki disease. Pediatrics 2012;129:e291-7. https://doi.org/10.1542/peds.2011-1704
  19. Anderson MS, Todd JK, Glode MP. Delayed diagnosis of Kawasaki syndrome: an analysis of the problem. Pediatrics 2005;115:e428-33. https://doi.org/10.1542/peds.2004-1824
  20. Tashiro N, Matsubara T, Uchida M, Katayama K, Ichiyama T, Furukawa S. See comment in PubMed Commons belowUltrasonographic evaluation of cervical lymph nodes in Kawasaki disease. Pediatrics 2002;109:E77-7. https://doi.org/10.1542/peds.109.5.e77

Cited by

  1. Recent advances in the diagnosis of Kawasaki disease vol.5, pp.1, 2017, https://doi.org/10.22470/pemj.2018.00220
  2. Diagnosis and management of Kawasaki disease vol.63, pp.7, 2017, https://doi.org/10.5124/jkma.2020.63.7.374
  3. Aseptic Meningitis, As the First Manifestation of Kawasaki Disease: A Case Report vol.11, pp.4, 2017, https://doi.org/10.5812/compreped.103101
  4. Evaluating Lymph Node Stiffness to Differentiate Bacterial Cervical Lymphadenitis and Lymph Node-First Presentation of Kawasaki Disease by Shear Wave Elastography vol.40, pp.7, 2017, https://doi.org/10.1002/jum.15518