Parapharyngeal and retropharyngeal infections in children: Kawasaki disease needs vigilance

• Published in: Brazilian journal of otorhinolaryngology Vol. 90; no. 3; p. 101405
• Main Authors: Liu, Jia, Zhou, Shui-Hong
• Format: Journal Article
• Language: English
• Published: Brazil Elsevier España S.L.U 01.05.2024; Elsevier; Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial
• Subjects: Cellulitis - etiology; Child; Child, Preschool; Deep neck infections; Diagnosis, Differential; Female; Humans; Infant; Kawasaki disease; Male; Mucocutaneous Lymph Node Syndrome - complications; Mucocutaneous Lymph Node Syndrome - diagnosis; Neck; Original; OTORHINOLARYNGOLOGY; Parapharyngeal infections; Parapharyngeal Space; Pharyngeal Diseases - etiology; Retropharyngeal Abscess - etiology; Retropharyngeal infections; Retrospective Studies; Surgical timing; Tomography, X-Ray Computed; Kawasaki disease; Retropharyngeal infections; Surgical timing; Deep neck infections; Parapharyngeal infections
• ISSN: 1808-8694; 1808-8686; 1808-8686
• DOI: 10.1016/j.bjorl.2024.101405

•Deep neck infections may manifest as an initial and atypical symptom of KD.•Otolaryngologists should maintain awareness of the possible manifestations of KD.•The operation should be cautious in cases that KD mimic deep neck abscesses. Kawasaki Disease (KD) may mimic Parapharyngeal (PPI) and Retropharyngeal Infections (RPI), leading to misdiagnosis as Deep Neck Infections (DNIs). The treatment plans for the two diseases are different, and delayed treatment can lead to serious complications. Therefore, prompt diagnosis and management are necessary. This study was performed to evaluate the clinical features of KD mimicking DNIs and explore the treatment options. Children with cellulitis or abscess in parapharyngeal or retropharyngeal space in neck CT were included in this study. The medical records of enrolled children were retrospectively reviewed. In total, 56 children were diagnosed with PPI or/and RPI. Twenty-two (39.3%) participants were eventually diagnosed with KD, and 34 (60.7%) were diagnosed with DNIs. Compared with the DNIs group, the KD group had a higher body temperature (p=0.007), and higher levels of AST (p=0.040), ALT (p=0.027), and ESR (p=0.030). Deep cervical cellulitis (p=0.005) were more common in the KD group. However, deep neck abscess often occurred in the DNIs group (p=0.002), with parapharyngeal abscess being the most common type of abscess (p=0.004). The KD mimicking DNIs cases did not respond to antibiotic treatment, but symptoms significantly improved after the use of Immunoglobulin (IVIG) and aspirin. Children with KD may exhibit retropharyngeal or parapharyngeal inflammation in the early stages. KD should be considered a differential diagnosis for children with DNIs, high fever, and no response to antibiotic therapy. Surgery in KD mimicking deep neck abscess requires caution. I.