10:15 AM - 11:05 AM
[III-JCKO7-03] Kawasaki Disease with Atypical Presentation Masquerading as Severe Infection: a 10-year retrospective review in a Tertiary Hospital in Hong Kong
Objective
Kawasaki disease (KD) can masquerade as severe infection: KD shock syndrome (KDSS) mimicking toxic shock; and retropharyngeal edema (RPE) mimicking neck abscess. They may delay diagnosis thus timely treatment.
Method
A 10-year (2007-2016) review was done for any KDSS / RPE.
Result
120 KD cases were recruited. M:F was 1.2:1, age 3.5 months-12 years old.
7 had RPE mimicking abscess (5.8%), presented as fever with neck complaints: swelling, pain or refusal to rotation/extension. None fulfilled diagnostic criteria of KD initially, some even with absent KD signs. They responded poorly to antibiotics. Neck X-ray showed thickened retropharyngeal space suspicious of abscess. Computer tomography (CT) showed retropharyngeal fluid with no definite rim-enhancement. One case in doubt of early abscess underwent fine needle aspiration yielding 1.5ml necrotic material, sterile for bacterial culture. KD signs emerged as clinical course progressed, and they responded well to immunoglobulin (IVIG) and aspirin.
3 presented as KDSS mimicking toxic shock (2.5%) with systolic hypotension needing inotropes and had ventricular dysfunction, mitral regurgitation on echocardiogram. Two had coronary ectasia on presentation. All were IVIG resistant which were well predicted by Egami score. Two required pulse methylprednisolone and remaining one responded to 2nd dose IVIG.
Conclusion
KD can present atypically leading to diagnostic confusion mimicking severe infections. High vigilance is needed for early diagnosis and timely treatment to minimize unnecessary operations and complications.
Kawasaki disease (KD) can masquerade as severe infection: KD shock syndrome (KDSS) mimicking toxic shock; and retropharyngeal edema (RPE) mimicking neck abscess. They may delay diagnosis thus timely treatment.
Method
A 10-year (2007-2016) review was done for any KDSS / RPE.
Result
120 KD cases were recruited. M:F was 1.2:1, age 3.5 months-12 years old.
7 had RPE mimicking abscess (5.8%), presented as fever with neck complaints: swelling, pain or refusal to rotation/extension. None fulfilled diagnostic criteria of KD initially, some even with absent KD signs. They responded poorly to antibiotics. Neck X-ray showed thickened retropharyngeal space suspicious of abscess. Computer tomography (CT) showed retropharyngeal fluid with no definite rim-enhancement. One case in doubt of early abscess underwent fine needle aspiration yielding 1.5ml necrotic material, sterile for bacterial culture. KD signs emerged as clinical course progressed, and they responded well to immunoglobulin (IVIG) and aspirin.
3 presented as KDSS mimicking toxic shock (2.5%) with systolic hypotension needing inotropes and had ventricular dysfunction, mitral regurgitation on echocardiogram. Two had coronary ectasia on presentation. All were IVIG resistant which were well predicted by Egami score. Two required pulse methylprednisolone and remaining one responded to 2nd dose IVIG.
Conclusion
KD can present atypically leading to diagnostic confusion mimicking severe infections. High vigilance is needed for early diagnosis and timely treatment to minimize unnecessary operations and complications.