Unusual manifestations of Kawasaki disease with retropharyngeal edema and shock syndrome in a Taiwanese child.
We report a 3-year-old girl with Kawasaki disease who presented with retropharyngeal edema and shock syndrome. This is the first reported case in Taiwan. The patient initially presented with fever, cough, and pyuria followed by rapidly progressive enlarged bilateral cervical lymphadenopathy. On the third day of the fever, computed tomography for airway compression sign found widening of the retropharyngeal space mimicking a retropharyngeal abscess. Later, an endotracheal tube was inserted for respiratory distress. A skin rash over her trunk was also noted. On the fifth day of the fever, the clinical course progressed to hypotension and shock syndrome. Because of more swelling of bilateral neck lymph nodes, computed tomography was arranged again and revealed partial resolution of the edematous changes in the retropharyngeal space. Edema of the hands and feet, bilateral bulbar conjunctivitis, and fissured lips were subsequently found. The diagnosis of Kawasaki disease was confirmed on the eighth day of fever. There was no evidence of bacterial infection. She was administered intravenous immunoglobulin (2 mg/kg) and high dose aspirin (100 mg/kg/day). One day later, the fever subsided, and her blood pressure gradually became stable. Heart echocardiography on the Day 13 revealed dilated left coronary artery and mitral regurgitation. Follow-up echocardiography six months later showed normal coronary arteries. To date, the patient has not experienced any complications. This case illustrates that retropharyngeal edema and shock syndrome can be present in the same clinical course of Kawasaki disease. Clinicians and those who work in intensive care units should be aware of unusual presentations of Kawasaki disease to decrease rates of cardiovascular complications.
['Fang|Li-Ching|LC|', 'Shyur|Shyh-Dar|SD|', 'Peng|Chun-Chih|CC|', 'Jim|Wai-Tim|WT|', 'Chu|Szu-Hung|SH|', 'Kao|Yu-Hsuan|YH|', 'Chen|Chen-Kuan|CK|', 'Liu|Ling-Chun|LC|']
D001241:Aspirin D002584:Cervix Uteri D002675:Child, Preschool D004487:Edema D005076:Exanthema D005260:Female D005334:Fever D006801:Humans D016756:Immunoglobulins, Intravenous D007155:Immunologic Factors D008199:Lymphadenitis D009080:Mucocutaneous Lymph Node Syndrome D010614:Pharynx D012769:Shock D012867:Skin D013624:Taiwan D014057:Tomography, X-Ray Computed
Kawasaki disease Retropharyngeal edema Shock