title: Retropharyngeal edema: an unusual manifestation of Kawasaki disease.
abstract: BACKGROUND
  Kawasaki disease (KD) is an acute multisystem vasculitis of unknown etiology that typically affects young children. KD presenting as a retropharyngeal inflammatory process is very rare.
  
  
  OBJECTIVE
  To report a case of KD initially presenting as a retropharyngeal edema mimicking a deep neck infection, and to review previously published reports in the literature.
  
  
  METHODS
  We report a case of KD in a previously healthy 3-year-old child who presented with acute onset of fever and cervical adenitis, along with computed tomography scan findings of retropharyngeal edema and inflammation. KD was suspected due to persistent fever and no improvement in the patient's condition despite appropriate antibiotic therapy; and other classic findings of KD eventually developed. An echocardiogram obtained on the 10th day of illness revealed pericardial effusion but no coronary ectasia or aneurysm. Treatment with high-dose intravenous immunoglobulin resulted in dramatic clinical improvement. Follow-up echocardiograms obtained 2 and 8 weeks after discharge revealed a small left coronary artery aneurysm (CAA). Nine months later, the CAA had resolved and the patient was well with no sequelae.
  
  
  CONCLUSIONS
  Although unusual, physicians should be aware of retropharyngeal edema as an atypical presentation of KD.
authors.affiliation: Department of Pediatrics, Wake Forest University Health Sciences and Brenner Children's Hospital, Winston-Salem, North Carolina 27157, USA.
authors.forename: Emily W
authors.initials: EW
authors.lastname: Langley
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Kirse
authors.forename: Craig E
authors.initials: CE
authors.lastname: Barnes
authors.forename: Wesley
authors.initials: W
authors.lastname: Covitz
authors.forename: Avinash K
authors.initials: AK
authors.lastname: Shetty
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002675:Child, Preschool; D004487:Edema / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D008199:Lymphadenitis / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications* / Q000000981:diagnostic imaging* / Q000188:drug therapy; D010608:Pharyngeal Diseases / Q000000981:diagnostic imaging* / Q000209:etiology*; D014057:Tomography, X-Ray Computed
chemical_list: D000893:Anti-Inflammatory Agents; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D001241:Aspirin