1 - A CASE OF INCOMPLETE KAWASAKI DISEASE WITH SUPPURATIVE CERVICAL LYMPHADENITIS IN AN INFANT

Introduction: Kawasaki disease is a self-limiting systemic inflammatory vasculitis that predominantly affects infants and young children. Cervical lymphadenopathy is the least common diagnostic feature in patients with KD. Several cases of KD with lymph-node-first presentation  accompanied by retropharyngeal abscess have been reported. However, to the best of our knowledge, cases of KD with suppurative cervical lymphadenitis, especially in infants, are exceedingly rare.

History and physical examination: We report the case of a 4-month-old infant who presented with a fever lasting of 6 days. At another hospital, swelling of the left cervical lymph nodes occurred on the second day of hospitalization, and antibiotics were administered. Unfortunately, the swelling and redness worsened, and fever persisted. Due to suspected incomplete KD, echocardiography was performed, revealing enlargement of the left main coronary artery (2.4 mm, z score=2.53). IVIG was administered, but fever persisted. She was transferred to our hospital. Upon admission, there was redness, swelling and tenderness on the left side of the neck.

Treatment and course: A second IVIG treatment was started. However, although the fever subsided, the left cervical lesion did not improve. Neck sonography indicated suppurative cervical lymphadenitis. Incision & drainage were performed, yielding a large amount of pus. Culture results showed the growth of Staphylococcus aureus. Cervical lymphadenitis improved after cefotaxime and clindamycin treatment.

Conclusion: This case report suggests that suppurative cervical lymphadenitis may occur very rarely in KD.