Cervical Lymphadenitis as an Initial Manifestation of Kawasaki Disease

以頸部淋巴腺炎為最初表徵之川崎病

邱婷芳(Ting-Fang Chiu) ； 林應然(Yung-Zen Lin) ； 連振祥(Cheng-Hsiang Lien) ； 李坤美(Kun-Mei Lee) ； 蔡洪瑩(Hung-Ying Tsai) ； 吳幸霖(Hsin-Lin Wu) ； 黃耀霆(Yao-Ting Huang) ； 楊勝君(Sheng-Chun Yang) ； 孫中淑(Chung-Shu Sun) ； 吳文豪(Wen-Hao Wu) ； 吳康文(Kang-)

《北市醫學雜誌》 2卷2期 (2005/02) Pp. 220-225

https://doi.org/10.6200/TCMJ.2005.2.2.13

摘要

川崎病為一不明原因的急性全身性血管炎，主要發生在五歲以下的幼兒。它的臨床表徵包括發燒、兩側非化膿性結膜炎、口腔黏膜發紅或草莓舌、皮疹、及頸部淋巴腺病變。如果未早期治療，百分之二十到二十五的病童會有冠狀動脈病變。我們報告一例八歲男孩，主訴為發燒及頸部淋巴腺炎，理學檢查在左側頸部有一8×4公分的淋巴結腫大及疼痛。在細菌性淋巴腺炎及中耳炎的診斷下，接受抗生素治療。在發燒的第五日出現嘴唇乾裂及草莓舌，在懷疑為非典型的川崎病下，他於發燒的第八日接受心臟超音波檢查，但是報告正常。直到在發病後第十四日，出現手指及腳趾末端脫皮，川崎病才確診。在年紀較大的病童，如果有發燒及頸部淋巴腺炎，一定要將川崎病列入鑑別診斷。尤其當抗生素治療反應不佳時，應仔細觀察是否有其他川崎病的表徵。早期使用免疫球蛋白治療，可以使冠狀動脈瘤的發生率小於百分之五。

關鍵字

川崎病 ； 頸部淋巴腺炎 ； 冠狀動脈瘤

並列摘要

Kawasaki disease is an acute systemic vasculitis of unknown etiology that affects predominantly children younger than 5 years. It is characterized by fever, bilateral nonexudative conjunctivitis, erythema of lips and oral mucosa, skin rash, and cervical lymphadenopathy. There is an extremely effective therapy; and there is a 20 to 25% chance of coronary abnormalities if the treatment is not given early in the course of the disease. We reported a case of 8-year-old boy who initially presented with fever and cervical lymphadenitis. Physical examination revealed one 8×4cm hard, tender warm mass over left neck. Fissured lips and strawberry tongue developed on the 5th day of fever. Although atypical Kawasaki disease was suspected, the echocardiography was negative on the 8th day of fever. He was eventually diagnosed as Kawasaki disease until 14th day of the illness when periungual desquamation occurred. It is important to consider Kawasaki disease in the broad differential diagnosis of fever and cervical lymphadenitis, particularly in older children. If the response to antibiotic treatment is poor, observe carefully if there are some features suggestive of Kawasaki disease. Early initiation of intravenous gamma globulin treatment can lower the risk of coronary artery aneurysms to less than 5%.

並列關鍵字

Kawasaki disease ； cervical lymphadenitis ； coronary artery aneurysm