Resistant cervical lymphadenitis in a 10-year-old child: case report

Purulent cervical lymphadenitis presents with different manifestations such as fever and Erythema of the skin at the site of infection. The appropriate treatment for purulent lymphadenitis are antibiotics. If there is no response to antibiotic treatment, other causes should be considered, including uncommon infectious causes (for example Mycobacterium infections or fungal infections), malignancy and Kawasaki diseases, etc. This study aimed to introduce a child with suspected purulent cervical lymphadenitis, who was initially presented with purulent lymphadenitis and was treated with broad-spectrum antibiotics. Due to the lack of response to treatment, further laboratory and clinical examinations were performed for him, then he was diagnosed with Kawasaki disease.

A 10-year-old boy with fever and severe cervical lymphadenitis was referred to Tehran Childrenchr('39')s Medical Center Hospital in May 2018. He had leukocytosis in his lab test and the acute reactant phase was high. He was diagnosed with purulent lymphadenitis and he was treated with broad-spectrum antibiotics. But no therapeutic response was observed, the patientchr('39')s fever continued and erythrocyte sedimentation rate (ESR) increased in the laboratory tests. The patientchr('39')s knee developed arthralgia, and Inflammation of the neck spread to the chest wall. Therefore echocardiography was performed. The patientchr('39')s left anterior descending artery (LAD) had ectasia in echocardiography (LAD>2/5 SD). The patient was diagnosed with atypical Kawasaki disease, therefore the appropriate treatment was started for him and a dramatic clinical response was seen. His fever stopped and the patientchr('39')s cervical lymphadenitis had completely improved. In the follow-up, the patientchr('39')s left anterior descending artery (LAD) ectasia was resolved.

Kawasaki disease is one of the causes of cervical lymphadenitis in children. If a patient with suspected purulent lymphadenitis is treated with appropriate antibiotics but no adequate response is seen, Kawasaki disease should be considered and the patient must be re-evaluated for Kawasaki disease.