[Kawasaki disease in children with initial manifestations mimicking deep neck infections: a clinical analysis of 14 cases].

Objective

To investigate the clinical characteristics of Kawasaki disease (KD) in children who initially present with symptoms of deep neck infections (DNIs).

Methods

A retrospective analysis was conducted on the clinical data of 14 children with KD initially presenting with DNI symptoms, who were admitted to Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, between January 2020 and June 2025. Their clinical features, diagnosis, and treatment process were analyzed. The cohort included 11 males and 3 females, aged from 1 year to 10 years and 11 months. SPSS 25.0 was used for statistical analysis.

Results

All patients were initially diagnosed with suppurative lymphadenitis or cervical abscess. Subsequent KD manifestations appeared. Two patients showed mild tricuspid and mitral regurgitation on cardiac ultrasound examination on the 3rd and 4th days of illness, respectively. The average time from onset to definitive KD diagnosis was (7.35±3.15) days. Two patients underwent incision and drainage for neck abscess before diagnosis, and one underwent retropharyngeal incision and drainage. All patients received the standard KD treatment regimen [intravenous immunoglobulin (IVIG) and oral aspirin] after diagnosis. Symptoms of the deep neck infection resolved in all cases, and no coronary artery dilation was observed.

Conclusion

In children presenting with symptoms of DNIs, e.g., neck swelling, pain, or mass, accompanied by persistent fever, clinicians should maintain a high index of suspicion for non infectious diseases such as KD. Timely cardiac ultrasound examination, early recognition, and prompt initiation of IVIG therapy are essential to avoid unnecessary invasive procedures.