title: Comparison between Kawasaki disease with lymph-node-first presentation and Kawasaki disease without cervical lymphadenopathy.
abstract: OBJECTIVE
  We evaluated the characteristics of patients with Kawasaki disease (KD) who presented with only fever and cervical lymphadenopathy on admission, and compared them with the characteristics of those who presented with typical features but no cervical lymphadenopathy.
  
  
  METHODS
  We enrolled 98 patients diagnosed with KD. Thirteen patients had only fever and cervical lymphadenopathy on the day of admission (group 1), 31 had typical features with cervical lymphadenopathy (group 2), and 54 had typical features without cervical lymphadenopathy (group 3).
  
  
  RESULTS
  The mean age (4.3±2.1 years) and duration of fever (7.5±3.6 days) before the first intravenous immunoglobulin (IVIG) administration were highest in group 1 (P=0.001). Moreover, this group showed higher white blood cell and neutrophil counts, and lower lymphocyte counts after the first IVIG administration as compared to the other groups (P=0.001, P=0.001, and P=0.003, respectively). Group 1 also had a longer duration of hospitalization and higher frequency of second-line treatment as compared to groups 2 and 3 (group 1 vs. group 2, P=0.000 and P=0.024; group 1 vs. group 3, P=0.000 and P=0.007). A coronary artery z score of >2.5 was frequently observed in group 1 than in group 3 (P=0.008).
  
  
  CONCLUSIONS
  KD should be suspected in children who are unresponsive to antibiotics and have prolonged fever and cervical lymphadenopathy, which indicates that KD is associated with the likelihood of requiring second-line treatment and risk of developing coronary artery dilatation.
authors.affiliation: Department of Pediatrics, Jeju National University Hospital, Jeju, Korea.
authors.forename: Jung Ok
authors.initials: JO
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Yeo Hyang
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Myung Chul
authors.initials: MC
authors.lastname: Hyun
keywords: Coronary artery; Fever; Immunoglobulin; Kawasaki disease; Lymphadenopathy