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Unusual manifestations of Kawasaki disease with retropharyngeal edema and shock syndrome in a Taiwanese child.
J Microbiol Immunol Infect. 2014 Apr; 47(2):152-7.JM

Abstract

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.

Authors+Show Affiliations

Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan. Electronic address: abc4540@gmail.com.Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

22503799

Citation

Fang, Li-Ching, et al. "Unusual Manifestations of Kawasaki Disease With Retropharyngeal Edema and Shock Syndrome in a Taiwanese Child." Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi, vol. 47, no. 2, 2014, pp. 152-7.
Fang LC, Shyur SD, Peng CC, et al. Unusual manifestations of Kawasaki disease with retropharyngeal edema and shock syndrome in a Taiwanese child. J Microbiol Immunol Infect. 2014;47(2):152-7.
Fang, L. C., Shyur, S. D., Peng, C. C., Jim, W. T., Chu, S. H., Kao, Y. H., Chen, C. K., & Liu, L. C. (2014). Unusual manifestations of Kawasaki disease with retropharyngeal edema and shock syndrome in a Taiwanese child. Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi, 47(2), 152-7. https://doi.org/10.1016/j.jmii.2012.01.017
Fang LC, et al. Unusual Manifestations of Kawasaki Disease With Retropharyngeal Edema and Shock Syndrome in a Taiwanese Child. J Microbiol Immunol Infect. 2014;47(2):152-7. PubMed PMID: 22503799.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Unusual manifestations of Kawasaki disease with retropharyngeal edema and shock syndrome in a Taiwanese child. AU - Fang,Li-Ching, AU - Shyur,Shyh-Dar, AU - Peng,Chun-Chih, AU - Jim,Wai-Tim, AU - Chu,Szu-Hung, AU - Kao,Yu-Hsuan, AU - Chen,Chen-Kuan, AU - Liu,Ling-Chun, Y1 - 2012/04/12/ PY - 2011/09/14/received PY - 2011/12/27/revised PY - 2012/01/20/accepted PY - 2012/4/17/entrez PY - 2012/4/17/pubmed PY - 2014/11/19/medline KW - Kawasaki disease KW - Retropharyngeal edema KW - Shock SP - 152 EP - 7 JF - Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi JO - J Microbiol Immunol Infect VL - 47 IS - 2 N2 - 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. SN - 1995-9133 UR - https://www.unboundmedicine.com/medline/citation/22503799/Unusual_manifestations_of_Kawasaki_disease_with_retropharyngeal_edema_and_shock_syndrome_in_a_Taiwanese_child_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1684-1182(12)00034-5 DB - PRIME DP - Unbound Medicine ER -