title: Lymph-node-first presentation of Kawasaki disease compared with bacterial cervical adenitis and typical Kawasaki disease.
abstract: OBJECTIVE
  To identify characteristics differentiating the node-first presentation of Kawasaki disease (NFKD) from bacterial cervical lymphadenitis (BCL) and typical Kawasaki disease (KD).
  
  
  METHODS
  From our prospectively collected database, we compared clinical, laboratory, and imaging characteristics of NFKD and BCL cohorts and performed multivariable logistic regression to identify variables that distinguish NFKD from BCL. We then compared outcomes of patients with NFKD and patients with typical KD treated during the same period.
  
  
  RESULTS
  Over 7 years, 57 patients were hospitalized for NFKD, 78 for BCL, and 287 for typical KD. Patients with NFKD were older and had more medical encounters and longer duration of illness before the correct diagnosis was made than did patients with BCL. Of patients with NFKD, 33% had an admission diagnosis of bacterial adenitis or abscess. Compared with patients with BCL, patients with NFKD had lower leukocyte (white blood cell), hemoglobin, and platelet counts and higher absolute band counts (ABCs), C-reactive protein (CRP), alanine transaminase and γ-glutamyl transpeptidase levels, and erythrocyte sedimentation rates. In the multivariable analysis, smaller nodes, lower white blood cell count, and higher ABC and CRP were independently associated with NFKD. Patients with NFKD had multiple enlarged solid nodes and comparable rates of retropharyngeal edema. Compared with patients with typical KD, patients with NFKD were older, had more severe inflammation, and had similar rates of coronary artery abnormalities and resistance to intravenous immune globulin.
  
  
  CONCLUSIONS
  High ABC and CRP values and multiple enlarged solid nodes in febrile patients with cervical adenopathy should prompt consideration of NFKD to prevent delayed diagnosis of KD. Retropharyngeal edema on radiography should not dissuade from the diagnosis of NFKD.
authors.affiliation: Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, CA, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Kanegaye
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Van Cott
authors.forename: Adriana H
authors.initials: AH
authors.lastname: Tremoulet
authors.forename: Andrea
authors.initials: A
authors.lastname: Salgado
authors.forename: Chisato
authors.initials: C
authors.lastname: Shimizu
authors.forename: Peter
authors.initials: P
authors.lastname: Kruk
authors.forename: John
authors.initials: J
authors.lastname: Hauschildt
authors.forename: Xiaoying
authors.initials: X
authors.lastname: Sun
authors.forename: Sonia
authors.initials: S
authors.lastname: Jain
authors.forename: Jane C
authors.initials: JC
authors.lastname: Burns
mesh_terms: D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis*; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D008198:Lymph Nodes / Q000473:pathology*; D008199:Lymphadenitis / Q000175:diagnosis*; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000175:diagnosis*; D011446:Prospective Studies