Ramaswamy Ganesh, et al. studies suggest that in a child with a persistent unexplained fever, the presence of any high parameters of inflamma- tion, anemia, low sodium, and albumin levels should alert clinicians to Kawasaki disease even in the absence of other clinical symptoms.12 In conclusion, Kawasaki disease need not always mani- fest with all its typical features as in our case where Kawa- saki disease mimicked a retropharyngeal abscess. The unu- sual clinical manifestations of KD reported in previous studies, which were initially clinically missed, are due to the lack of a specific diagnostic test. Hence, a high index of suspicion and careful and repeated examination are needed to prevent dreaded complications of KD. REFERENCES 1. Stamos JK, Corydon K, Donaldson J, Shulman ST. Lymphaden- itis as the dominant manifestation of Kawasaki disease. Pediatrics 1994;93:525-8. 2. Rowley AH, Shulman ST. Kawasaki disease. In: Behrman RE, Kliegman RM, Jenson HB, editors. Nelson textbook of Pediatrics. 17th ed. Philadeplhia: WB Saunders Co.; 2004. p.793-834. 3. Burgner D, Festa M, Isaacs D. Delayed diagnosis of Kawasaki disease presenting with massive lymphadenopathy and airway obstruction. BMJ 1996;312:1471-2. 4. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, Ame- rican Heart Association. Pediatrics 2004;114:1708-33. 5. Rothfield RE, Arriaga MA, Felder H. Peritonsillar abscess in Kawasaki disease. Int J Pediatr Otorhinolaryngol 1990;20:73-9. 6. Pontell J, Rosenfeld RM, Kohn B. Kawasaki disease mimicking retropharyngeal abscess. Otolaryngol Head Neck Surg 1994;110: 428-30. 7. Park AH, Batchra N, Rowley A, Hotaling A. Patterns of Kawasaki syndrome presentation. Int J Pediatr Otorhinolaryngol 1997;40: 41-50. 8. McLaughlin RB Jr, Keller JL, Wetmore RF, Tom LW. Kawasaki disease: a diagnostic dilemma. Am J Otolaryngol 1998;19:274-7. 9. Homicz MR, Carvalho D, Kearns DB, Edmonds J. An atypical presentation of Kawasaki disease resembling a retropharyngeal abscess. Int J Pediatr Otorhinolaryngol 2000;54:45-9. 10. Gross M, Eliashar R, Attal P, Sichel JY. Radiology quiz case 2: Kawasaki disease (KD) mimicking a retropharyngeal abscess. Arch Otolaryngol Head Neck Surg 2001;127:1507, 1508-9. 11. Hung MC, Wu KG, Hwang B, Lee PC, Meng CC. Kawasaki disease resembling a retropharyngeal abscess--case report and literature review. Int J Cardiol 2007;115:e94-6. 12. Falcini F. Kawasaki disease. Curr Opin Rheumatol 2006;18:33-8. 786 Yonsei Med J http://www.eymj.org Volume 51 Number 5 September 2010