1- Unidade de Infecciologia, Área de Pediatria Médica, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central EPE, Lisboa
2- Unidade de Neuropediatria, Área de Pediatria Médica, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central EPE, Lisboa
3- Serviço de Neurorradiologia, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central EPE, Lisboa
33rd Annual Meeting of the European Society for Paediatric Infectious Diseases, Leipzig, 12-16 de Maio de 2015 (Poster)
Resumo:
Background and aims: Kawasaki disease (KD) is an acute, systemic, self-limited vasculitis.
The diagnosis is clinic and not always straightforward. Rarely, retropharyngeal phlegmon has been described as first manifestation of Kawasaki disease, which makes the differential diagnosis more difficult.
Case reports: We report two children, a four-year-old girl and six-year-old boy, who presented with fever and cervical pain. Neck swelling, torticollis, neck stiffness and trismus were observed. Retropharyngeal cellulitis (low density without rim enhancement) was diagnosed on CT and penicillin plus clindamycin were started. No pus was obtained on drainage and cultures were negative. By the seventh illness day fever persisted and a skin rash, conjunctival injection, mucositis and edema of the hands dorsum and feet developed. Both patients desquamated and one had arthralgia. Analyses revealed leukocytosis, left-shift in white blood cell count, elevation of acute phase reactants, anemia and elevation of transaminases. No cardiac involvement was noted. One patient received high-dose intravenous immunoglobulin therapy plus aspirin with defervescence in twenty-four hours. The other patient remained feverish till the tenth day of disease without specific treatment.
At two month follow-up, there was no cardiac involvement in both cases.
Conclusion: These cases highlight KD atypical presentations. Although no cardiac involvement was noted, the negative cultures and lack of clinical response to antibiotics suggest KD. Furthermore, the typical KD features and the flu edema on imagiology support the diagnosis.
Palavras-chave: Kawasaki disease; retropharyngeal phlegmon; children