Clinical Characteristics Of Kawasaki Disease With Deep Neck Space Involvement

Objective: Deep neck space involvement(DNSI)is a rare and serious complication of Kawasaki disease(KD),which is easily neglected in clinical practice.Early diagnosis and active intervention can improve the prognosis of the disease.In this study,in order to improve clinicians’ understanding of this complication,the clinical data of patients with KD complicated with DNSI were analyzed retrospectively,the clinical characteristics were summarized and the early warning indicators were explored.Methods:(1)The clinical data of 38 patients with KD complicated with DNSI admitted to the Department of Rheumatology and Immunology of Shenzhen Children’s Hospital from January 2018 to December 2020 were collected and sorted out,including clinical manifestations,auxiliary examination,treatment,prognosis,etc.The disease characteristics of KD complicated with DNSI were summarized by using a descriptive approach for the statistical analysis;(2)These patients with KD complicated with DNSI were taken as the observation group,and 288 patients with KD admitted to our hospital at the same time were taken as the control group.The differences in clinical characteristics between both groups were compared via the difference analysis;(3)The early warning indicators of KD complicated with DNSI were explored through the multivariate logistic regression analysis.Results:(1)A total of 38 patients(26 males and 12 females)with KD complicated with DNSI were included in the observation group,with the onset age being 41(19.2,59.2)months.As for the clinical manifestations,all patients suffered from fever with cervical lymph node enlargement,including flushing lips in 37 cases(97.4%),conjunctival congestion in 34 cases(89.5%),rash in 28 cases(73.7%),and swelling or desquamation of fingers and toes in 24 cases(63.2%);Besides,there were 25 cases(65.8%)with limited cervical movement,7 cases(18.4%)with upper airway obstruction and 2 cases(5.3%)with a sore throat.As for the auxiliary examination,the neck imaging of all patients showed DNSI with different degrees;Echocardiography showed that 8 patients(21.1%)had coronary artery dilatation,among which 7 patients had a small coronary artery aneurysm and 1 patient had a medium coronary artery aneurysm.As for the efficacy,35 patients(92.1%)were sensitive to IVIG,22 patients(57.9%)were treated with IVIG combined with glucocorticoid,37 patients(97.4%)were treated with antibiotics,and 1 patient underwent neck abscess incision and drainage.(2)Compared with the control group,the patients in the observation group had older onset age [41.0(19.2,59.2)months vs 23.0(13.0,40.0)months,P<0.05] and longer hospitalization time[10.0(8.0,12.8)days vs 6.0(5.0,7.0)days,P<0.05].Patients in the observation group featured such characteristic signs as cervical lymph node swelling and pain,limited cervical movement and upper airway obstruction.The count and percentage of neutrophils,high-sensitivity C-reactive protein and serum ferritin levels of patients in the observation group were higher than those in the control group;while the count and percentage of lymphocytes and platelet levels of patients in the observation group were lower than those in the control group.All the above indicators were statistically different(P<0.05).However,there was no significant difference in blood white blood cells,erythrocyte sedimentation rate and procalcitonin between both groups(P>0.05).Moreover,there was no significant difference in the incidence of coronary artery dilatation between the observation group and the experimental group(21.1% vs 17.0%,P=0.697>0.05).As for the treatment,compared with the control group,the utilization rate of antibiotics in the observation group was higher(97.4% vs 59.7%,P<0.001),and the anti-infection time in the observation group was longer(9.0 days(7.2,11.8)vs 3.0days(0.0,5.0),P<0.001).In addition,there were significant differences in the early warning scores of various KD complicated with coronary artery diseases between both groups,including KOBAYASHI score,SANO score,FU score and HARADA score;while there was no significant difference in EGAMI score between both groups.(3)As per the multivariate logistic regression analysis of patients in both groups,cervical lymph node pain,limited cervical movement,and the increase of CRP and FER have certain predictive value for KD complicated with DNSI.Conclusion:KD complicated with DNSI is not rare in clinical practice,but its manifestations are insidious,resulting in a tendency to be missed and misdiagnosed.Cervical lymph node swelling and pain,limited cervical movement or upper airway obstruction is significant clinical indications for KD complicated with DNSI.CRP and FER have certain predictive value for DNSI,and cervical imaging examination conduces to diagnosis.Patients with KD complicated with DNSI are usually accompanied by a more serious systemic inflammatory reaction and often need more active anti-inflammatory treatment or early anti-infection treatment.