Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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Differential Diagnosis of Bacterial Cervical Lymphadenitis and Kawasaki Disease in Patients with Fever and Cervical Lymphadenopathy

발열과 림프절 종대를 보인 환자에서 화농성 경부 림프절염과 가와사키병의 감별 진단

  • Jang, Homin (Department of Pediatrics, CHA Bundang Medical Center, CHA University) ;
  • Ha, Eun Gyo (Department of Pediatrics, CHA Bundang Medical Center, CHA University) ;
  • Kim, Hee Jin (Department of Pediatrics, CHA Bundang Medical Center, CHA University) ;
  • Lee, Taek-jin (Department of Pediatrics, CHA Bundang Medical Center, CHA University)
  • 장호민 (차 의과학대학교 분당차병원 소아청소년과) ;
  • 하은교 (차 의과학대학교 분당차병원 소아청소년과) ;
  • 김희진 (차 의과학대학교 분당차병원 소아청소년과) ;
  • 이택진 (차 의과학대학교 분당차병원 소아청소년과)
  • Received : 2016.06.09
  • Accepted : 2016.09.21
  • Published : 2016.12.25
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Abstract

Purpose: This study identified the characteristics differentiating node-first presentation of Kawasaki disease (NFKD) from bacterial cervical lymphadenitis (BCL) and typical Kawasaki disease (KD). Methods: From July 2007 to June 2015, the medical records of patients with BCL, NFKD, and typical KD were retrospectively reviewed. We analyzed and compared the demographic, clinical, laboratory, and imaging characteristics of the cohorts. Results: Twenty-two patients with BCL, 37 with NFKD, and 132 with typical KD were included in this study. Patients with BCL had longer durations of hospitalization than patients with NFKD. Bilateral and multiple enlarged cervical lymph nodes were associated more with NFKD than BCL. Compared with BCL patients, NFKD patients had lower platelet counts, higher percentages of neutrophils, and higher C-reactive protein (CRP) levels. NFKD patients were older and presented with higher white blood cell counts, percentages of neutrophils, absolute neutrophil counts, and CRP levels as well as lower platelet counts and alanine aminotransferase levels than typical KD patients. Conclusions: In febrile patients with cervical lymphadenopathy, the combination of bilateral and multiple enlarged nodes, low platelet count, high percentage of neutrophils, and high CRP levels should prompt consideration of NFKD for prevention of delayed diagnosis of KD.

목적: 경부 림프절 종대를 먼저 보인 가와사키병(node-first presented Kawasaki disease [NFKD])에 대한 임상 연구를 통해 세균 경부 림프절염(bacterial cervical lymphadenitis [BCL]), 전형적인 가와사키병(Kawasaki disease [KD])과 구별되는 특징을 찾고자 하였다. 방법: 2007년부터 2015년까지 BCL, NFKD, 전형적인 KD로 입원한 환자들의 의무기록을 검토하여 인구학적 특성, 임상 양상, 혈액검사 및 영상의학적 검사 결과를 후향적으로 비교 분석하였다. 결과: 22명의 BCL, 37명의 NFKD, 132명의 전형적인 KD 환자가 연구에 포함되었다. BCL과 NFKD의 비교에서 BCL군의 입원 기간이 더 길었고 NFKD군은 양측, 다발형 림프절 비대를 보이면서 혈소판 수가 적고 호중구 백분율과 CRP 수치가 높았다. NFKD와 전형적인 KD의 비교에서 NFKD군의 나이가 더 많았고 백혈구 수, 호중구 백분율, 호중구 수, CRP 수치가 높고 혈소판 수와 ALT 수치가 낮았다. 결론: 발열과 경부 림프절 종대가 있는 환자에서 호중구 백분율과 CRP 수치가 높고 혈소판 수치가 높지 않으면서 양측, 다발형 경부 림프절 비대를 보인다면, KD의 진단 및 치료가 지연되지 않도록 NFKD 진단을 신속하게 고려하여야 한다.

Keywords

References

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