Кawasaki disease in a 7-year-old boy mimicking a peritonsillar abscess
DOI:
https://doi.org/10.15574/SP.2026.1(153).157162Keywords:
Kawasaki disease, coronary artery aneurysms, peritonsillar abscess, acetylsalicylic acid, intravenous immunoglobulin, children, echocardiography, vasculitis, feverAbstract
Aim - to analyze a clinical case of incomplete Kawasaki disease (KD) with atypical manifestations and to highlight the importance of early recognition in pediatric patients presenting with persistent fever unresponsive to antimicrobial therapy.
Clinical case. This report describes an atypical presentation of KD in a 7-year-old child manifesting as a presumed peritonsillar abscess, representing a rare otorhinolaryngological phenotype that significantly complicated the diagnostic process. A previously healthy boy was admitted with a 4-day history of high-grade fever, odynophagia, and painful cervical lymphadenopathy. Initial clinical assessment suggested a peritonsillar abscess; however, needle aspiration yielded no purulent discharge. Empirical antibiotic therapy failed to achieve clinical improvement. Magnetic resonance imaging excluded abscess formation and demonstrated inflammatory changes consistent with tonsillitis and cervical lymphadenopathy. By day 7 of illness, progressive thrombocytosis and bilateral non-exudative conjunctival injection were observed. Based on the constellation of clinical features (prolonged fever, mucocutaneous involvement, lymphadenopathy) and laboratory findings (elevated inflammatory markers, anemia, thrombocytosis), a diagnosis of incomplete KD was established in accordance with the American Heart Association guidelines. Treatment of intravenous immunoglobulin (IVIG) in combination with acetylsalicylic acid resulted in rapid defervescence and marked clinical improvement. Serial echocardiographic evaluations revealed no coronary artery abnormalities.
Conclusions. KD should be considered in the differential diagnosis of pediatric patients with fever lasting more than 5 days and presumed bacterial infections refractory to antibiotic therapy. Early recognition and timely initiation of IVIG therapy are critical for reducing the risk of coronary artery complications. Heightened awareness among clinicians, particularly in otorhinolaryngology and emergency settings, is essential.
The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from the children's parents.
The authors declare no conflict of interest.
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