Journal of Cardiovascular Imaging

Korean Society of Echocardiography (한국심초음파학회)
권호 표지
DOI QR코드

DOI QR Code

Imaging and Clinical Data Distinguish Lymphadenopathy-First-Presenting Kawasaki Disease from Bacterial Cervical Lymphadenitis

  • Park, Byung Sung (Department of Pediatrics, Hallym University Sacred Heart Hospital) ;
  • Bang, Myung Hoon (Department of Pediatrics, Hallym University Sacred Heart Hospital) ;
  • Kim, Sung Hye (Department of Pediatrics, Hallym University Sacred Heart Hospital)
  • Received : 2018.10.22
  • Accepted : 2018.11.28
  • Published : 2018.12.27
⟨ Previous Next ⟩

Abstract

BACKGROUND: Kawasaki disease (KD) sometimes presents with only fever and cervical lymphadenopathy before other clinical signs materialize. This lymphadenopathy-first-presenting Kawasaki disease (LKD) may be misdiagnosed as bacterial cervical lymphadenitis (BCL). We investigated characteristic imaging and clinical data for factors differentiating LKD from BCL. METHODS: We compared imaging, clinical, and laboratory data of patients with KD and BCL. We included patients admitted to a single tertiary center between January 2015 and July 2018. RESULTS: We evaluated data from 51 patients with LKD, 63 with BCL, and 218 with typical KD. Ultrasound imaging revealed multiple enlarged lymph nodes in both LKD and BCL patients. On the other hand, computed tomography (CT) showed more abscesses in patients with BCL. Patients with LKD were younger and showed higher systemic and hepatobiliary inflammatory markers and pyuria than BCL patients. In multivariable logistic regression, younger age and higher C-reactive protein (CRP) retained independent associations with LKD. A comparison of the echocardiographic findings in LKD and typical KD showed that patients with LKD did not have a higher incidence of coronary artery abnormalities (CAA). CONCLUSIONS: LKD patients tend to have no abscesses on CT and more elevated systemic hepatobiliary inflammatory markers and pyuria compared to BCL patients. The absence of abscess on CT, younger age, and elevated CRP were the most significant variables differentiating LKD from BCL. There was no difference in CAA between LKD and typical KD.

Keywords

References

  1. McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation 2017;135:e927-99.
  2. Wang CL, Wu YT, Liu CA, Kuo HC, Yang KD. Kawasaki disease: infection, immunity and genetics. Pediatr Infect Dis J 2005;24:998-1004. https://doi.org/10.1097/01.inf.0000183786.70519.fa
  3. 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
  4. 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
  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. https://doi.org/10.1016/j.jpeds.2012.11.064
  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. Yun HW, Lee JY, Yang SI, et al. Comparison of cervical-lymph-node-first presentation of Kawasaki disease and typical Kawasaki disease. Pediatr Infect Vaccine 2016;23:10-7. https://doi.org/10.14776/piv.2016.23.1.10
  8. Jun WY, Ann YK, Kim JY, et al. Kawasaki disease with fever and cervical lymphadenopathy as the sole initial presentation. Korean Circ J 2017;47:107-14. https://doi.org/10.4070/kcj.2016.0160
  9. Waggoner-Fountain LA, Hayden GF, Hendley JO. Kawasaki syndrome masquerading as bacterial lymphadenitis. Clin Pediatr (Phila) 1995;34:185-9. https://doi.org/10.1177/000992289503400403
  10. 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
  11. 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
  12. Dallaire F, Dahdah N. New equations and a critical appraisal of coronary artery Z scores in healthy children. J Am Soc Echocardiogr 2011;24:60-74. https://doi.org/10.1016/j.echo.2010.10.004
  13. Roh K, Lee SW, Yoo J. CT analysis of retropharyngeal abnormality in Kawasaki disease. Korean J Radiol 2011;12:700-7. https://doi.org/10.3348/kjr.2011.12.6.700
  14. Kato H, Kanematsu M, Kato Z, Teramoto T, Kondo N, Hoshi H. Computed tomographic findings of Kawasaki disease with cervical lymphadenopathy. J Comput Assist Tomogr 2012;36:138-42. https://doi.org/10.1097/RCT.0b013e31823b4497
  15. Tona R, Shinohara S, Fujiwara K, et al. Risk factors for retropharyngeal cellulitis in Kawasaki disease. Auris Nasus Larynx 2014;41:455-8. https://doi.org/10.1016/j.anl.2014.05.017
  16. Nozaki T, Morita Y, Hasegawa D, et al. Cervical ultrasound and computed tomography of Kawasaki disease: Comparison with lymphadenitis. Pediatr Int 2016;58:1146-52. https://doi.org/10.1111/ped.13017

Cited by

  1. Diagnostic Applications for Clinical and Imaging Data in Kawasaki Disease with Lymphadenopathy-First-Presentation vol.26, pp.4, 2018, https://doi.org/10.4250/jcvi.2018.26.e32
  2. Kawasaki disease: characteristics, diagnosis, and unusual presentations vol.15, pp.10, 2019, https://doi.org/10.1080/1744666x.2019.1659726
  3. 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, 2018, https://doi.org/10.1002/jum.15518