Case Report DOI 10.3349/ymj.2010.51.5.784 pISSN: 0513-5796, eISSN: 1976-2437 Yonsei Med J 51(5):784-786, 2010 Kawasaki Disease Mimicking Retropharyngeal Abscess Ramaswamy Ganesh,1 Vazhkudai Sridharan Srividhya,1 Thiruvengadam Vasanthi,1 and Somu Shivbalan2 1Department of Pediatrics, Kanchi Kamakoti Childs Trust Hospital, Chennai; 2Pediatrician and Pulmonologist, Sundaram Medical Foundation and Dr Rangarajan Memorial Hospital, Chennai, India. Received: March 31, 2008 Revised: May 21, 2008 Accepted: June 3, 2008 Corresponding author: Dr. Ramaswamy Ganesh, Department of Pediatrics, Kanchi Kamakoti Childs Trust Hospital, 12- A, Nageswara road, Nungambakkam, Chennai-600034, TamilNadu, India. Tel: 91-44-42001800, Fax: 91-44-28259633 E-mail: ganeped79@rediffmail.com ∙The authors have no financial conflicts of interest. © Copyright: Yonsei University College of Medicine 2010 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non- Commercial License (http://creativecommons.org/ licenses/by-nc/3.0) which permits unrestricted non- commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 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 retro- pharyngeal abscess, with upper airway obstruction resulting in delayed diagnosis. Key Words: Kawasaki disease, retropharyngeal abscess INTRODUCTION Kawasaki disease (KD) is an acute, self-limiting febrile mucocutaneous vasculitis of infants and children. Diagnosis of KD is clinical and is based on the presence of fever with other features suggestive of KD, lymphadenopathy being the least common. Retropharyngeal abscess mimicking KD has been rarely reported from India. We discuss an 8-year-old boy presenting initially with a retropharyngeal abscess and upper airway obstruction, later developing a full-blown KD, thus resulting in a delayed diagnosis of KD. CASE REPORT An 8-year-old boy presented with fever, pain on the left side of the neck asso- ciated with restricted neck movements, and trismus for 1 day. He also had difficulty in swallowing and breathing. On examination he was febrile (104˚F), toxic, anxious, irritable, and a throat examination revealed a 4×5 cm swelling in the posterior pharyngeal wall to the left of the midline. He also had upper deep left cervical lymphadenopathy and there was no cyanosis. His respiratory rate was 48/min, and he had suprasternal indrawing and stridor. His systemic examination was normal. Investigations revealed a total white blood count (WBC) count: 20,800/mm3, polymorphs: 80%, platelet count: 3.5 lacs/mm3, erythrocyte sedimen- tation rate (ESR): 55 mm/hr, and a C reactive protein (CRP) of 48 mg/dL. Blood cultures showed no growth. A lateral neck X-ray revealed widening of the retropharyngeal space and narrowing of the upper airway. Computed tomography (CT) of the neck revealed ill-defined hypodense lesion extending from the C2-C6 vertebral level in the posterior pharyngeal space with no contrast enhancement compatible with a diagnosis of retropharyngeal abscess (Fig. 1). In light of the high fever and toxemia, he was started on antibiotics (Cefotaxim 100 mg/kg/day) and surgical aspiration was undertaken within 24 hours of the antibiotics and yielded 784 Yonsei Med J http://www.eymj.org Volume 51 Number 5 September 2010