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Kawasaki Disease Presenting as Retropharyngeal Cellulitis

Objective: Kawasaki disease (KD), which occurs in infants and children, is an acute multisystemic vasculitis of unknown etiology. Several reports mentioned retropharyngeal cellulitis as a rare manifestation of KD. The purpose of this study is to investigate the population and characteristics of KD manifested by retropharyngeal soft tissue swelling. Method: A retrospective review of 213 patients (mean age of 2 years, age range of 7 months to 10 years) diagnosed as KD between 2005 and 2010. Results: Enhanced computed tomography showed an abnormal low density area without ring enhancement in the retropharyngeal space in 9 cases (4.2%). All of them had fever and cervical lymphadenopathy as the first symptom. Though cervical lymphadenopathy is one of the 6 diagnostic features of KD (fever, skin rash, cervical lymphadenopathy, conjunctivitis, fissuring of lips, and strawberry tongue), the occurrence is reported to be the lowest (about 50%). They were treated by a pediatrician as suppurative lymphadenitis in 6 cases and as retropharyngeal cellulitis in 3 cases, and they were finally diagnosed as KD owing to ineffectiveness of antibiotics or emergence of the other symptoms. Conclusion: A low density area on computed tomography in the retropharyngeal space was identified in 4.2% of KD. Early diagnosis is essential in KD because coronary artery lesions emerge in 50% of patients without treatment. If a young child has fever, cervical lymphadenopathy and swelling of the retropharyngeal space, KD should be within differential diagnoses.