Comparison of Cervical-lymph-node-first Presentation of Kawasaki Disease and Typical Kawasaki Disease

Hye-Won Yun; Jun-Yeol Lee; Song-I Yang; Hee-Joon Yu; Min-Jae Kang; So-Yeon Lee; Hae-Ran Lee; Kwang-Nam Kim; Sung-Hye Kim

doi:10.14776/piv.2016.23.1.10

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Yun, Lee, Yang, Yu, Kang, Lee, Lee, Kim, and Kim: Comparison of Cervical-lymph-node-first Presentation of Kawasaki Disease and Typical Kawasaki Disease

Original Article

Pediatric Infection & Vaccine 2016; 23(1): 10-17.

Published online: 30 April 2016

DOI: https://doi.org/10.14776/piv.2016.23.1.10

Comparison of Cervical-lymph-node-first Presentation of Kawasaki Disease and Typical Kawasaki Disease

Hye-Won Yun, Jun-Yeol Lee, Song-I Yang, Hee-Joon Yu, Min-Jae Kang, So-Yeon Lee, Hae-Ran Lee, Kwang-Nam Kim, Sung-Hye Kim

Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.

Corresponding author (rohetkim@yahoo.co.kr)

Received 11 August 2015 Revised 6 October 2015 Accepted 17 October 2015

Abstract

Purpose

The diagnosis of Kawasaki disease depends on clinical symptoms, which makes it difficult to diagnose early in patients with only cervical lymphadenopathy. The purpose of this study is to understand the clinical characteristics of cervical-lymph-node-first presentation of Kawasaki disease and compare them with those of typical Kawasaki disease.

Methods

We surveyed 283 patients who were admitted to Hallym Sacred Heart Hospital and were diagnosed with Kawasaki disease from January 2012 to December 2014. The patients were divided into two groups: cervical-lymph-node-first presentation of Kawasaki disease (LKD, N=24) and typical Kawasaki disease (KD, N=259). The medical records were retrospectively reviewed.

Results

The mean age of the LKD group was higher than that of the KD group (P=0.04). At admission, the LKD patients had on average 1.62 out of 5 symptoms, whereas the KD patients had 3.47. The time from fever to diagnosis and administration of IV immunoglobulin was longer in the LKD group than in the KD group (P<0.001). The mean C-reactive protein of the LKD group was higher than that of the KD group (P=0.01). There were no statistical differences in the presence of coronary artery complications between the two groups at two weeks or at two months after diagnosis (P=0.52, P=0.08).

Conclusions

The Kawasaki disease patients with fever and cervical lymphadenopathy usually do not present obvious clinical symptoms, which makes it hard to diagnose in the early phase of disease. Clinician must pay attention when examining these patients.

Keywords: Kawasaki disease, Cervical lymph node, Children

Figures and Tables

Table 1

Comparison of Characteristics between Cervical-lymph-node-first Presentation of Kawasaki Disease Group and Typically Manifested Kawasaki Disease Group

Abbreviation: IVIG, intravenous immunoglobulin.

^*Symptoms observed at admission.

^†Including BCG scar site redness.

^‡Days from fever onset to the day of admission.

^∫Days from fever onset to the day diagnosed as Kawasaki disease and received IVIG treatment.

^∥Days from the day of admission to the day diagnosed as Kawasaki disease and received IVIG treatment.

^¶Cases received antibiotics at admission.

^**Cases received 2^nd IVIG because of sustained fever or relapsed fever after 36 hours of 1^st IVIG treatment.

Table 2

Laboratory Results in the Cervical-lymph-node-first Presentation of Kawasaki Disease Group and Typically Manifested Kawasaki Disease Group at Admission

Abbreviations: WBC, White blood cell; ESR, Erythrocyte sedimentation rate; CRP, C-reactive protein; AST, aspartate aminotransferase; ALT, alanine aminotransferase; γ-GT, γ-glutamyltransferase; BNP, brain natriuretic peptide.

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