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

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...

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Autores principales: Rossi, Felipe de Souza, da Silva, Marco Felipe Castro, Kozu, Kátia Tomie, Camargo, Luís Fernando Aranha, Rossi, Flávia Feijó Panico, Silva, Clovis Artur, Campos, Lúcia Maria de Arruda
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Instituto de Ensino e Pesquisa Albert Einstein 2015
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4943791/
https://www.ncbi.nlm.nih.gov/pubmed/26132362
http://dx.doi.org/10.1590/S1679-45082015RC2987
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author Rossi, Felipe de Souza
da Silva, Marco Felipe Castro
Kozu, Kátia Tomie
Camargo, Luís Fernando Aranha
Rossi, Flávia Feijó Panico
Silva, Clovis Artur
Campos, Lúcia Maria de Arruda
author_facet Rossi, Felipe de Souza
da Silva, Marco Felipe Castro
Kozu, Kátia Tomie
Camargo, Luís Fernando Aranha
Rossi, Flávia Feijó Panico
Silva, Clovis Artur
Campos, Lúcia Maria de Arruda
author_sort Rossi, Felipe de Souza
collection PubMed
description 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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spelling pubmed-49437912016-08-10 Extensive cervical lymphadenitis mimicking bacterial adenitis as the first presentation of Kawasaki disease Rossi, Felipe de Souza da Silva, Marco Felipe Castro Kozu, Kátia Tomie Camargo, Luís Fernando Aranha Rossi, Flávia Feijó Panico Silva, Clovis Artur Campos, Lúcia Maria de Arruda Einstein (Sao Paulo) Case Report 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. Instituto de Ensino e Pesquisa Albert Einstein 2015 /pmc/articles/PMC4943791/ /pubmed/26132362 http://dx.doi.org/10.1590/S1679-45082015RC2987 Text en http://creativecommons.org/licenses/by-nc/3.0/ 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.
spellingShingle Case Report
Rossi, Felipe de Souza
da Silva, Marco Felipe Castro
Kozu, Kátia Tomie
Camargo, Luís Fernando Aranha
Rossi, Flávia Feijó Panico
Silva, Clovis Artur
Campos, Lúcia Maria de Arruda
Extensive cervical lymphadenitis mimicking bacterial adenitis as the first presentation of Kawasaki disease
title Extensive cervical lymphadenitis mimicking bacterial adenitis as the first presentation of Kawasaki disease
title_full Extensive cervical lymphadenitis mimicking bacterial adenitis as the first presentation of Kawasaki disease
title_fullStr Extensive cervical lymphadenitis mimicking bacterial adenitis as the first presentation of Kawasaki disease
title_full_unstemmed Extensive cervical lymphadenitis mimicking bacterial adenitis as the first presentation of Kawasaki disease
title_short Extensive cervical lymphadenitis mimicking bacterial adenitis as the first presentation of Kawasaki disease
title_sort extensive cervical lymphadenitis mimicking bacterial adenitis as the first presentation of kawasaki disease
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4943791/
https://www.ncbi.nlm.nih.gov/pubmed/26132362
http://dx.doi.org/10.1590/S1679-45082015RC2987
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