Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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인두후부의 농양과 유사하게 표현된 비전형적인 가와사끼병

Atypical presentation of Kawasaki disease resembling a retropharyngeal abscess

  • 김유진 (충북대학교 의과대학 소아과학교실) ;
  • 임영수 (충북대학교 의과대학 소아과학교실) ;
  • 윤지은 (충북대학교 의과대학 소아과학교실) ;
  • 한헌석 (충북대학교 의과대학 소아과학교실)
  • Kim, Eu Jin (Department of Pediatrics, Chungbuk National University, College of Medicine) ;
  • Lim, Young Su (Department of Pediatrics, Chungbuk National University, College of Medicine) ;
  • Yoon, Ji Eun (Department of Pediatrics, Chungbuk National University, College of Medicine) ;
  • Han, Heon-Seok (Department of Pediatrics, Chungbuk National University, College of Medicine)
  • 투고 : 2008.08.05
  • 심사 : 2008.10.16
  • 발행 : 2009.02.15
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초록

가와사끼병은 급성 전신적 염증성 질환으로, 그 원인은 아직 밝혀지지 않았고, 임상양상은 비특이적으로 많은 소아의 감염성 질환이나 면역학적 질환에서도 볼 수 있다. 저자들은 발열과 경부 임파선병증을 보인 두 증례에서 경부 전산화단층촬영상 인두후부의 농양과 유사한 소견을 보였으나 항생제 치료에 반응하지 않으며 인두 후부의 흡인술에서도 농양이 없던 경우로, 시간이 지나면서 전형적인 가와사끼 증상의 출현과 함께 심초음파에서 방실 판막의 역류를 보여 늦게 진단할 수 있었다. 본 증례에서처럼 발열과 경부임파선병증으로 나타나는 경우에도 가와사끼병을 의심해야 하며, 이 경우 전산화단층촬영에서 인두후부의 농양 유사 병변은 위양성 소견으로 볼 수 있다. 경부임파선병증이 적절한 항생제치료에도 불구하고 발열 등의 증상이 지속되는 경우에는, 심초음파를 포함한 검사를 조기에 시행하여 불필요한 내과적, 외과적 치료를 줄여야 할 필요가 있겠다.

Kawasaki disease is an acute systemic inflammatory disorder, the etiology of which has not yet been established. The clinical manifestations are non-specific and are common to many pediatric infectious and immunologic diseases. In 2 cases presenting fever, cervical lymphadenopathy, and retropharyngeal abscess-like lesions on the neck shown in a computerized tomography (CT) scan, the diagnosis of Kawasaki disease was delayed. The patients were not responsive to antibiotic therapy, and fluid collection was not found during retropharyngeal aspiration. They showed typical Kawasaki manifestations over time and atrioventricular valve regurgitation in the echocardiogram. A diagnosis of Kawasaki disease should be considered in similar cases of fever and cervical lymphadenopathy. A CT scan that shows a retropharyngeal abscess-like lesion on the neck can be a false positive finding, and other laboratory exams, including echocardiography, should be performed as early as possible to avoid unnecessary medical and surgical procedures.

키워드

과제정보

연구 과제 주관 기관 : Chungbuk National University

참고문헌

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피인용 문헌

  1. Kawasaki Disease Presenting as Cervical Lymphadenitis and Retropharyngeal Abscess vol.53, pp.9, 2009, https://doi.org/10.3342/kjorl-hns.2010.53.9.552
  2. A case of Kawasaki disease with coexistence of a parapharyngeal abscess requiring incision and drainage vol.53, pp.9, 2009, https://doi.org/10.3345/kjp.2010.53.9.855
  3. Atypical presentation of Kawasaki disease in young infants mimicking a retropharyngeal abscess vol.19, pp.2, 2012, https://doi.org/10.1007/s10140-011-1005-0
  4. Adult Recurrence of Kawasaki Disease Mimicking Retropharyngeal Abscess vol.56, pp.16, 2009, https://doi.org/10.2169/internalmedicine.8399-16