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      Extensive cervical lymphadenitis mimicking bacterial adenitis as the first presentation of Kawasaki disease

      case-report

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          Abstract

          Cervical adenitis >1.5cm in diameter is the less frequently observed criteria in patients with Kawasaki disease and it is usually found in association with other symptoms during the acute phase. Moreover, the finding of fever and lymphadenitis with intense local signs of inflammation and phlegmon is rarely seen as the initial manifestation of Kawasaki disease. We report the case of a 7-year-old boy who had cervical lymphadenitis with adjacent cellulitis and phlegmon mimicking bacterial adenitis as the first presentation of Kawasaki disease. The patient had fever, cervical lymphadenitis with adjacent cellulitis, and severe headache. Cefadroxil was prescribed based on the clinical diagnosis of bacterial adenitis. Because he remained febrile and phlogistic signs worsened, after 1 day of hospitalization, antibiotics were administrated intravenously (ceftriaxone and oxacillin). The computed tomography of the neck showed primary infectious/inflammatory process. On the fourth day, the patient had dry and scaly lips, and treatment with oxacillin was replaced by clindamycin because the patient was still febrile. On the ninth day, he presented non-exudative bilateral conjunctival injection. On the tenth day of febrile disease, a rash appeared on his trunk, hands and feet. Patient’s symptoms resolved after intravenous administration of immunoglobulin (2g/kg/dose), and he was discharged 2 days later. On the 14th day, the patient had lamellar desquamation of fingers. Kawasaki disease should be considered as a differential diagnosis in children with febrile cervical lymphadenitis unresponsive to empiric antibiotics even if they have adjacent cellulitis and phlegmon.

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          Most cited references10

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          A new infantile acute febrile mucocutaneous lymph node syndrome (MLNS) prevailing in Japan.

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            Infections and Kawasaki disease: implications for coronary artery outcome.

            We sought to determine the effect of coincident infection, at time of diagnosis of Kawasaki disease (KD), on treatment response and coronary artery outcome. A single-center, retrospective study of 129 consecutive patients diagnosed with typical KD between January 1997 and December 1998 was performed. Standardized clinical assessments, laboratory, microbiology, and imaging test results plus treatment regimens were reviewed. Coronary arteries were visualized by using echocardiography, and coronary artery lesions (CALs) were reported as body surface area-adjusted z scores. Infection-positive and -negative groups were identified, and clinical, laboratory, and treatment data were analyzed. The effect of infections and other outcome variables on CAL development was determined by multivariate regression analysis. (1) Concurrent infections: 33% of children with typical KD had > or =1 confirmed infection at KD diagnosis. (2) Treatment response: the presence of infection did not alter the response to treatment with intravenous immunoglobulin, with resolution of fever in 83% of children after 1 dose of intravenous immunoglobulin together with aspirin administration regardless of presence or absence of infection. (3) Coronary outcome: in total, 31% of the patients developed CALs. Both the proven-infection and no-proven-infection groups had a similar CAL frequency. (4) Multivariate regression analysis: proven infection did not increase the risk of coronary artery involvement even after adjusting for other factors impacting on coronary artery outcomes. Infections are common at diagnosis of KD. A broad spectrum of infectious agents was found. Infections at diagnosis of KD did not affect the patients' response to treatment and coronary artery outcome when compared with those patients without infections.
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              Lymph-node-first presentation of Kawasaki disease compared with bacterial cervical adenitis and typical Kawasaki disease.

              To identify characteristics differentiating the node-first presentation of Kawasaki disease (NFKD) from bacterial cervical lymphadenitis (BCL) and typical Kawasaki disease (KD).
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                Author and article information

                Journal
                Einstein (Sao Paulo)
                Einstein (Sao Paulo)
                Einstein
                Instituto de Ensino e Pesquisa Albert Einstein
                1679-4508
                2317-6385
                Jul-Sep 2015
                Jul-Sep 2015
                : 13
                : 3
                : 426-429
                Affiliations
                [1 ]Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
                [2 ]Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
                [1 ]Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.
                [2 ] Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
                Author notes
                [Corresponding author ]: Lúcia Maria de Arruda Campos – Avenida Éneas de Carvalho Aguiar, 647 – Zip code: 05403-000 – São Paulo, SP, Brazil – Phone: (55 11) 3814-8481. E-mail: lucia@ 123456arrudacampos.com
                Autor correspondente: Lúcia Maria de Arruda Campos – Avenida Éneas de Carvalho Aguiar, 647 – CEP: 05403-000 – São Paulo, SP, Brasil – Tel.: (11) 3814-8481. E-mail: lucia@arrudacampos.com
                Article
                S1679-45082015RC2987
                10.1590/S1679-45082015RC2987
                4943791
                26132362
                4a74fcae-5e51-4f01-bc30-7074fce0a18f

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 27 September 2013
                : 29 August 2014
                Page count
                Figures: 8, Tables: 0, Equations: 0, References: 11, Pages: 1
                Categories
                Case Report

                mucocutaneous lymph node syndrome,child,lymphadenitis,cellulitis,diagnosis, differential,case reports,síndrome de linfonodos mucocutâneos,criança,linfadenite,celulite,diagnóstico diferencial,relatos de casos

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