Kawasaki disease is an acute, self-limiting febrile mucocutaneous vasculitis of infants and young children. Retropharyngeal lymphadenopathy is a rare presentation of Kawasaki disease. We present a case of Kawasaki disease mimicking a retropharyngeal abscess, with upper airway obstruction resulting in delayed diagnosis.
Child ; Humans ; Male ; Mucocutaneous Lymph Node Syndrome/*diagnosis/*pathology ; Retropharyngeal Abscess/*pathology

OBJECTIVETo review the recent diagnosis and treatment experience with deep neck infection and emphasize the importance of radiologic evaluation, microbiology and appropriate treatment selection in these patients.

METHODSA respective review was conducted in 95 cases who were diagnosed as having deep neck from Jan. 2006 to March 2015.

RESULTSThe primary diseases in 95 patients with deep neck infection were acute tonsillitis or acute laryngitis (27 cases), infection of upper respiratory tract (23 cases), odontogenic infection or oral inflammation (16 cases), foreign bodies in esophagus (9 cases), acute cervical lymphadenitis (5 cases) and cause uncertain (15 cases). Computed tomography was performed in all of patients to identify the location, extent, and character (cellulitis in 47 cases or abscesses in 48 cases) of the infections. The locations of abscess were parapharyngeal abscess (25 cases), retropharyngeal abscess (9 cases), submaxillary space abscess (6 cases), pretracheal space abscess (5 cases) and esophageal abscess (3 cases).

COMPLICATIONSmediastinitis (2 cases), pericarditis (1 case), bilateral pneumothorax (2 cases), and upper digestive tract (1 case). Bacterial cultivation performed in 35 patients and positive results were detected in 21. All patients were given intravenous antibiotic therapy. Tracheotomy was performed in 4 cases. Preoperative contrast enhanced CT was performed in 42 patients and indicated the formation of abscess. Three cases with the symptoms of septic shock were transferred to ICU and one was cured. All the patients were cured except two who died of massive hemorrhage of upper digestive tract and septic shock.

CONCLUSIONSThe airway patency in patients with deep neck infections must be ensured. Drainage may be mandatory in selected cases at presentation or in cases who fail to respond to parenteral antibiotics within the first 24-48 hours. Imaging evaluation plays a significant role in the diagnosis and rational therapeutic management in deep neck infection. Bacterial cultivation can help to make the effective treatment and provide reliable evidence for the etiopathogenisis.

Anti-Bacterial Agents ; therapeutic use ; Bacterial Infections ; drug therapy ; Cellulitis ; pathology ; Drainage ; Esophagus ; pathology ; Foreign Bodies ; pathology ; Humans ; Laryngitis ; microbiology ; pathology ; Neck ; microbiology ; pathology ; Retropharyngeal Abscess ; pathology ; Retrospective Studies ; Tomography, X-Ray Computed ; Tonsillitis ; microbiology ; pathology ; Treatment Outcome