Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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Comparison of Cervical Lymphadenitis as First Presentation of Kawasaki Disease and Acute Unilateral Cervical Lymphadenitis

경부 림프절염로 발현된 가와사키병과 급성 편측 경부 림프절염의 비교

  • Lee, Hoon Sang (Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine) ;
  • Kim, Ji Yong (Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine) ;
  • Song, Bo Kyung (Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine) ;
  • Kim, Yong-Woo (Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine) ;
  • Park, Su Eun (Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine)
  • 이훈상 (부산대학교 어린이병원 소아청소년과) ;
  • 김지용 (부산대학교 어린이병원 소아청소년과) ;
  • 송보경 (부산대학교 어린이병원 소아청소년과) ;
  • 김용우 (양산부산대학교병원 영상의학과) ;
  • 박수은 (부산대학교 어린이병원 소아청소년과)
  • Received : 2016.08.18
  • Accepted : 2016.10.12
  • Published : 2016.12.25
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Abstract

Purpose: This study aimed to identify the differential clinical, laboratory, and imaging characteristics between patients with cervical lymphadenitis as first presentation of Kawasaki disease (CLKD) and those with acute unilateral cervical lymphadenitis (AUCL). Methods: We surveyed 372 patients who visited Pusan National University Children's Hospital because of fever and cervical lymph node enlargement, and underwent neck computed tomography (CT) from January 2010 to December 2014. We compared 28 confirmed cases of Kawasaki disease and 28 cases of AUCL based on a retrospective review of the medical records of the patients. Results: Patients with CLKD and AUCL showed no differential clinical characteristics in terms of the duration of fever, antibiotic use, or the size of lymph nodes. Patients with CLKD had higher white blood cell count, absolute neutrophil count, erythrocyte sedimentation rate, and C-reactive protein levels (P<0.05) than those of patients with AUCL. The presence of retropharyngeal edema on neck CT was similar between the groups (64% vs. 33%, P=0.686). Conclusions: CLKD and AUCL showed no differentiating clinical and radiological characteristics; hence, Kawasaki disease should be the presumptive diagnosis in patients with fever and cervical lymph node enlargements who fail to respond to antibiotic treatment.

목적: 본 연구는 경부 림프절 비대로 시작된 가와사키병과 급성 편측 경부 림프절염 환자에서 임상 양상, 혈액검사 소견, 경부 컴퓨터단층촬영 소견에 차이가 있는지 확인하고자 하였다. 방법: 2010년 1월부터 2014년 12월까지 발열과 경부 림프절 비대로 부산대학교 어린이병원에 내원하여 경부 컴퓨터단층촬영을 시행한 환자 총 372명 중에 가와사키병으로 진단된 28명의 환자군과 편측 경부 림프절염 환자군 28명을 후향적으로 비교하였다. 결과: 경부 림프절염으로 발현된 가와사키병과 급성 편측 경부 림프절염에서 발열 기간, 항생제 사용, 경부 림프절 크기에는 차이가 없었다. 혈액검사 소견에서 CLKD 환자에서 AUCL 환자와 비교해서 총 백혈구 수, 호중구 수, 적혈구 침강 속도, C-반응단백 수치가 더 높은 것으로 나타났다(P<0.05). 경부 컴퓨터단층촬영 소견에서 후인두부 부종 소견은 두 군 간에 차이가 없었다(P=0.686). 결론: CLKD와 AUCL을 조기에 구별할 수 있는 특징적인 소견은 없는 것으로 보이기 때문에 발열과 경부 림프절 비대가 있는 환자에서 항생제 치료에도 증상 개선이 없다면 가와사키병을 고려해야겠다.

Keywords

References

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