以頭部急性腫大為初始表現的川崎病

Kawasaki Disease Presenting as Acute Neck Swelling

李俊昌(Chun-Chang Lee) ； 張正成(Jeng-Sheng Chang) ； 周郁文(Yu-Wen Chou)

《台灣耳鼻喉頭頸外科雜誌》 39卷4期 (2004/10) Pp. 161-165

https://doi.org/10.6286/2004.39.4.161

摘要

背景：發燒伴隨頸部淋巴腺炎或深頸部感染是基層醫療門診中常見的主訴之一，往往被視為細菌感染而以抗生素治療。但是川崎病(Kawasaki disease)有些也會以頸部淋巴腺炎為初始表現，其發燒型態並無法以抗生素或退燒藥來控制。本研究旨在描述一群以頸部淋巴腺炎或深頸部感染為主要初始表現的川崎病患者，並探討其處理原則。
方法：本研究乃收集2001年l月至2004年3月，於本院診治之18歲以下的川崎病患者中，以頸部淋巴腺炎、蜂窩性組織炎或是深頸部感染為主要初始表現的病人，總共6名，回溯整理其病歷記錄，並追蹤後續的併發症。
結果：6名病患中，男性5名，女性名。年齡分布方面，除l例為小於2個月之新生兒外，其餘大都分佈於2歲至6歲之間（l 歲11個月到5歲5個月）。從發病開始到確立川崎病的診斷，平均約7.2天（6到9天）。每1例在剛發病時都接受經驗性抗生素治療，其中有4例在出現川崎病特有的多形性皮膚紅疹時，被當做藥物過敏來治療。追蹤期間（l個月至16個月），除兩例有二尖瓣脫垂外，其餘都沒有留下後遺症。
結論：對6歲以下的幼童，若有發燒合併頸部淋巴腺腫大，並對抗生素及退燒藥的反應不佳時，應將川崎病納入鑑別診斷之中

關鍵字

川崎病 ； 頸部淋巴腺炎 ； 蜂窩性組織炎 ； 深頸部感染

並列摘要

BACKGROUND: The aim of this retrospective study is to describe a group of patients with Kawasaki disease presenting as cervical lymphadenitis, cellulitis, or deep neck infection.
METHODS: Between January 2001 and March 2004, we reviewed the medical records of all patients younger than 18 years of age with the final diagnosis of Kawasaki disease. Six children with the initial impression of cervical lymphadenitis, cellulitis or deep neck infection but for which a diagnosis of Kawasaki disease was established later were enrolled in this study.
RESULTS: There were five males but only one female. Most patients aged from 2 to 6 years except one neonate. The mean duration for establishing a diagnosis of Kawasaki disease from the onset of illness was 7.2 (6 to 9) days. Empiric antibiotics were administered in each case. Among four of them, polymorphous skin rash developed after antibiotic administration but was treated as drug allergy. During follow up period (one month to 16 months), all children recovered well without complications except two of them mitral valve prolapse was noted.
CONCLUSION: If a child less than 6 years of age has fever with enlarged cervical lymph node and is unresponsive to empiric antibiotics, Kawasaki disease should be considered.

並列關鍵字

Kawasaki disease ； cervical lymphadenitis ； cellulites ； deep neck infection