Comparison of Cervical Lymphadenitis as First Presentation of Kawasaki Disease and Acute Unilateral Cervical Lymphadenitis

Hoon Sang Lee; Ji Yong Kim; Bo Kyung Song; Yong-Woo Kim; Su Eun Park

doi:10.14776/piv.2016.23.3.217

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Lee, Kim, Song, Kim, and Park: Comparison of Cervical Lymphadenitis as First Presentation of Kawasaki Disease and Acute Unilateral Cervical Lymphadenitis

Original Article

Pediatr Infect Vaccine 2016;23(3):217-222.

Published online: 21 January 2016

DOI: https://doi.org/10.14776/piv.2016.23.3.217

Comparison of Cervical Lymphadenitis as First Presentation of Kawasaki Disease and Acute Unilateral Cervical Lymphadenitis

Hoon Sang Lee¹, Ji Yong Kim¹, Bo Kyung Song¹, Yong-Woo Kim², Su Eun Park¹

¹Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea

²Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea

Received 18 August 201628 September 2016 Accepted 12 October 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study aimed to identify the differential clinical, laboratory, and imaging characteristics between patients with cervical lymphadenitis as first presentation of Kawasaki disease (CLKD) and those with acute unilateral cervical lymphadenitis (AUCL).

Methods

We surveyed 372 patients who visited Pusan National University Children's Hospital because of fever and cervical lymph node enlargement, and underwent neck computed tomography (CT) from January 2010 to December 2014. We compared 28 confirmed cases of Kawasaki disease and 28 cases of AUCL based on a retrospective review of the medical records of the patients.

Results

Patients with CLKD and AUCL showed no differential clinical characteristics in terms of the duration of fever, antibiotic use, or the size of lymph nodes. Patients with CLKD had higher white blood cell count, absolute neutrophil count, erythrocyte sedimentation rate, and C-reactive protein levels (P<0.05) than those of patients with AUCL. The presence of retropharyngeal edema on neck CT was similar between the groups (64% vs. 33%, P=O.686).

Conclusions

CLKD and AUCL showed no differentiating clinical and radiological characteristics; hence, Kawasaki disease should be the presumptive diagnosis in patients with fever and cervical lymph node enlargements who fail to respond to antibiotic treatment.

Keywords: Mucocutaneous lymph node syndrome, Lymphadenitis, Fever, Child

REFERENCES

1. Leung AK, Davies HD. Cervical lymphadenitis: etiology, diagnosis, and management. Curr Infect Dis Rep. 2009; 11:183–9.

2. Kim GB, Han JW, Park YW, Song MS, Hong YM, Cha SH, et al. Epidemiologic features of Kawasaki disease in South Korea: data from nationwide survey, 2009-2011. Pediatr Infect Dis I. 2014; 33:24–7.

3. Ayusawa M, Sonobe T, Uemura S, Ogawa S, Nakamura Y, Kiyosawa N, et al. Revision of diagnostic guidelines for Kawasaki disease (the 5th revised edition). Pediatr Int. 2005; 47:232–4.

4. Burns IC, Mason WH, Glode MP, Shulman ST, Melish ME, Meissner C, et al. Clinical and epidemiologic characteristics of patients referred for evaluation of possible Kawasaki disease. United States Multicenter Kawasaki Disease Study Group. I Pediatr. 1991; 118:680–6.

5. Kao HT, Huang YC, Lin TY. Kawasaki disease presenting as cervical lymphadenitis or deep neck infection. Otolaryngol Head Neck Surg. 2001; 124:468–70.

6. Park AH, Batchra N, Rowley A, Hotaling A. Patterns of Kawasaki syndrome presentation. Int J Pediatr Otorhinola-ryngol. 1997; 40:41–50.

7. Kanegaye IT, Van Cott E, Tremoulet AH, Salgado A, Shimizu C, Kruk P, et al. Lymph-node-first presentation of Kawasaki disease compared with bacterial cervical adenitis and typical Kawasaki disease. I Pediatr. 2013; 162:1259–63.

8. Waggoner-Fountain LA, Hayden GF, Hendley JO. Kawasaki syndrome masquerading as bacterial lymphadenitis. Clin Pediatr (Phila). 1995; 34:185–9.

9. Stamos IK, Corydon K, Donaldson I, Shulman ST. Lymphadenitis as the dominant manifestation of Kawasaki disease. Pediatrics. 1994; 93:525–8.

10. Yanagi S, Nomura Y, Masuda K, Koriyama C, Sameshima K, Eguchi T, et al. Early diagnosis of Kawasaki disease in patients with cervical lymphadenopathy. Pediatr Int. 2008; 50:179–83.

11. Kim JO, Kim YH, Hyun MC. Comparison between Kawasaki disease with lymph-node-first presentation and Kawasaki disease without cervical lymphadenopathy. Korean J Pediatr. 2016; 59:54–8.

12. Kubota M, Usami I, Yamakawa M, Tomita Y, Haruta T. Kawasaki disease with lymphadenopathy and fever as sole initial manifestations. I Paediatr Child Health. 2008; 44:359–62.

13. Yun HW, Lee JY, Yang SI, Yu HJ, Kang M], Lee SY, et al. Comparison of cervical-lymph-node-ﬂrst presentation of Kawasaki disease and typical Kawasaki disease. Pediatr Infect Vaccine. 2016; 23:10–7.

14. Roh K, Lee SW, Yoo I. CT analysis of retropharyngeal abnormality in Kawasaki disease. Korean I Radiol. 2011; 12:700–7.

15. Nozaki T, Morita Y, Hasegawa D, Makidono A, Yoshimoto Y, Starkey I, et al. Cervical ultrasound and computed tomography of Kawasaki disease: comparison with lymphadenitis. Pediatr Int. 2016; 58:1146–52.

16. Nomura Y, Arata M, Koriyama C, Masuda K, Morita Y, Hazeki D, et al. A severe form of Kawasaki disease presenting with only fever and cervical lymphadenopathy at admission. J Pediatr. 2010; 156:786–91.

Table 1.

Clinical and Treatment Characteristics of Patients with CLkD and Initial Presentation

Characteristic	CLKDF (n=28)	AUCL (n=28)	P-value
Age (yr)	3.0(0-5)	3.9(0-5)	0.020
male sex	18(64.2)	19(67.9)	0.677
LN enlargement duration at first presentation (day)	3.0(1-7)	5.8(1-9)	0.109
Fever duration at first presentation (day)	4.0(1-8)	3.1(1-5)	0.133
Size of node (CM)	3.3(1.5-5)	3.1(1.5-6)	0.733
Diagnosis at admission
Kawasaki disease	6(21.4)	0
Cervical lymphadenitis	22(78.5)	28(100)
Preadmission antibiotic	15(53.6)	11(39.3)	0.257
Duration of preadmission antibiotic therapy (day)	1.8(0-8)	2.3(0-5)	0.668
Inpatient antibiotic	22(78.6)	23(82.1)	0.285
Duration of inpatient antibiotic therapy (day)	2.1(0-5)	4.3(1-7)	0.000
Total fever duration	6.3(5-9)	3.8(19)	0.000

Values are presented as median (range) or number(%).

Abbreviations: CLKD, cervical lymphadenitis as first presentation of kawaski disease; AUCL, acute unilaeral cervical lymphadenitis; LN, lymph node.

Table 2.

Laboratpory Vaues in patients with CLKD and AUCL at initial Presentation

Variable	CLKD (n=28)	AUCL(=28)	P-value
WBC(cells/μL)	19,326(8,410-39,410)	15,132(4,510-29,310)	0.047
ANC(cells/μL)	15,000(3,410-29,770)	9,610(650-29,770)	0.018
Hemoglobin(g/dL)	11.5(9.1-13.2)	11.6(10.0-14.7)	0.690
Platelet(10³ cells /muL)	313(73-685)	299(151-436)	0.808
ESR(mm/hr)	69(9-120)	45(5-120)	0.001
CRP(mg/dL)	10.67(2.76-26.31)	4.39(0.35-1873)	0.000
AST(IU/L)	153(21-523)	44(20-294)	0.206
ALT(IU/L)	103(7-560)	35(6-392)	0.253
LDH(IU/L)	646(399-1,219)	621(360-1,187)	0.693

Values are presented as median (range). abreviations: CLKD, cervical lymphadenitis as first presentation of Kawasaki disease; AUCL, acute unilateral cervical lymphadenitis; WBC, white blood cell; ANC, absolute neutrophil count; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; AST, aspartate aminotransferase; ALT, alanine aminotransferase; LDH, lactate dehydrogenase.

Table 3.

Neck Computed Tomography Findings in Patients vith CLKD and AUCL Based on Blinded Readings at Initial presentation

Variable	CLKD (n=28)	AUCL (n=28)	P-value
Location			0.743
Anterior cervical	19(68)	16(57)
Posterior triangle	7(25)	10(36)
Submandibular	2(7)	2(7)
Necrosis	6(21)	9(32)	0.946
Contrast enhancement(LN/muscle)	1.55	1.71	0.101
Retropharyngeal low attenuation	18(64)	9(33)	0.686
Retropharyngeal LN	13(46)	11(39)	0.937
Palatine soft tissue inflammation	26(93)	27(96)	0.787
Adjacent soft tissue inflammation	21(75)	13(46)	0.835

Values are presented as number (%) Abreviations: CLKD, cervical lymphadenitis as first presentation of Kawasaki disase; AUCL, acute unilateral cervical lymphadenitis; LN, lymph node.

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