Published online Apr 6, 2022. doi: 10.12998/wjcc.v10.i10.3170
Peer-review started: July 17, 2021
First decision: November 11, 2021
Revised: November 12, 2021
Accepted: February 22, 2022
Article in press: February 22, 2022
Published online: April 6, 2022
Processing time: 255 Days and 3.2 Hours
To the best of our knowledge, cases of Kawasaki disease (KD) occurring at the age of 12 are rare, even in Asia where the incidence of KD is high. We report a case of lymph-node-first presentation of KD (NFKD) in a 12-year-old girl with Myco
A previously healthy 12-year-old girl presented with fever, myalgia, sore throat, swelling, and tenderness on the right side of the neck. She was initially diagnosed with lymphadenitis caused by M. pneumoniae refractory to macrolide antibiotics. She had elevated brain natriuretic peptide (BNP) levels. Finally, the patient was diagnosed with KD. After receiving intravenous immunoglobulin, the fever resolved, and her symptoms improved.
NFKD should be differentiated from adolescent lymphadenitis presenting with prolonged fever by checking the BNP level early.
Core Tip: We report the case of a 12-year-old girl with lymphadenitis caused by Mycoplasma pneumoniae refractory to macrolide antibiotics. The fever persisted, and the patient did not respond to macrolide (clarithromycin) administered for 72 h. The brain natriuretic peptide (BNP) level, additionally measured to diagnose atypical Kawasaki disease (KD), was 427.2 ng/mL. A slight QT interval prolongation and a dilated right coronary artery were detected. She was finally diagnosed with lymph-node-first presentation of KD. Even if adolescent lymphadenitis with confirmed bacterial or viral infection does not have other symptoms of KD, early measurement of BNP levels can help diagnose KD.