Retropharyngeal abscess as a pitfall in the diagnosis of kawasaki disease: case report and review of the literature

Kawasaki disease (KD) is an acute self-limiting vasculitis of childhood of unknown etiology. We report the case of a patient with KD whose initial presentation mimicked a retropharyngeal abscess (RA) and review the literature on this topic. Our child, a 4 year old girl, presented with fever (< 24 hours) and clinical, laboratory and MRI findings consistent with RA. She received prompt intravenous antibiotic therapy with no clinical improvement. Only repeated accurate physical examinations, with early appreciation of subsequent clinical findings consistent with KD, allowed for early diagnosis and proper treatment with intravenous immunoglobulin. In literature sixteen cases of KD mimicking RA have been reported. Fever and deep neck infection like symptoms were the only clinical findings at admission in 14 (87.5%) children. All children had a neck CT scan performed showing findings suggestive of RA. All children were promptly started intravenous antibiotic therapy without clinical improvement and five patients (31%) underwent unproductive surgical drainage of the retropharyngeal space. Twelve patients (80%) received a diagnosis of KD after 7 or more days since onset of fever and 4 after 10 or more days. Coronary aneurisms were found in 2 patients, both of whom had a delayed KD diagnosis after 10 or more days since fever onset. Conclusion Pediatricians should be aware of atypical KD presentations mimicking RA. Early diagnosis of KD is pivotal for preventing cardiac complications, as well as avoiding the risk associated to unnecessary surgical intervention