cervical lymphadenitis as the first presentation of kawasaki disease: a case report

Background and objective: while kawasaki disease (kd) is common in asia, the incidence of lymph-node-first presentation of kawasaki disease (nfkd) in infants is unusual. we present the case of a nine-month-old boy with nfkd.case report: a previously healthy nine-month-old boy presented with symptoms including fever, tenderness, erythema, and severe edema. physical examination revealed neck swelling and restricted mobility due to lymph node enlargement on the left side of his neck. the initial diagnosis of antibiotic-resistant bacterial lymphadenitis was made. additional signs and symptoms included bilateral non-exudative bulbar conjunctivitis, erythema of the oral and pharyngeal mucosa accompanied by a reddened tongue and lips, erythema of the hands and feet, and the progressive development of a maculopapular rash. laboratory tests revealed elevated levels of c-reactive protein (crp) and erythrocyte sedimentation rate (esr). an echocardiogram indicated a coronary artery abnormality. the patient was diagnosed with nfkd after meeting the diagnostic criteria for kd. treatment was initiated with intravenous immune globulin (ivig), aspirin and methylprednisolone. following ivig administration, his fever subsided and his symptoms improved. conclusions: kd should be considered as a differential diagnosis in febrile infants with cervical adenopathy; patients meeting these criteria should be evaluated for this condition.