Published online Aug 6, 2023. doi: 10.12998/wjcc.v11.i22.5391
Peer-review started: May 21, 2023
First decision: June 13, 2023
Revised: June 25, 2023
Accepted: July 17, 2023
Article in press: July 17, 2023
Published online: August 6, 2023
Processing time: 73 Days and 18.3 Hours
Kawasaki disease (KD), also known as mucocutaneous lymph node syndrome, is an acute, self-limiting vasculitis of unknown aetiology that mainly involves the medium and small arteries and can lead to serious cardiovascular complications, with a 25% incidence of coronary artery aneurysms. Periton–Sillar abscesses are a rare symptom of KD and is easily misdiagnosed at its early stages.
A 5-year-old boy who presented to a community hospital with a 3-d fever, difficulty in opening his mouth, and neck pain and was originally treated for throat infection without improvement. On the basis of laboratory tests, ultrasound of submandibular and superficial lymph nodes and computed tomography of the neck, the clinician diagnosed the periamygdala abscess and sepsis that did not resolve after antibiotic therapy. On the fifth day of admission, the child developed conjunctival congestion, prune tongue, perianal congestion and desquamation, and slightly stiff and swollen bunions on both feet. A diagnosis of KD was reached with complete remission after intravenous immunoglobulin treatment.
Children with neck pain, lymph node enlargement, or airway obstruction as the main manifestations are poorly treated with intravenous broad-spectrum antibiotics. Clinicians should not rush invasive operations such as neck puncture, incision, and drainage and should be alert for KD when it cannot be explained by deep neck space infection and early treatment with aspirin combined with gammaglobulin.
Core Tip: Some typical symptoms of a suppurative infection of the deep neck fever, for example elevated white blood cell count, lymph node enlargement, and abnormal changes in the head and neck, may also be atypical manifestations of Kawasaki disease (KD). For cases with a long course of fever and no response to antibiotic treatment, careful observation of symptoms, signs, and cervical imaging findings in the progression of the disease can be used to detect KD with deep neck changes as the first symptom early and avoid the occurrence of serious complications.