川崎病并发咽旁间隙炎性改变1例报告及文献复习

Kawasaki disease with inflammatory changes in parapharyngeal space:A case report and literature review

目的:探讨以并发咽旁间隙和咽后间隙炎性改变为主要表现的川崎病患儿的临床特征、诊疗和预后,以提高临床医生对该病的认识。方法:回顾分析2019年11月于本科住院的1例以咽旁间隙受累为主要表现的川崎病患儿的临床资料,并对既往文献进行复习总结,分析川崎病并发头颈部症状患者的临床表现和影像学检查特征。结果:患儿,男性,3岁,因发热8 d伴颈部活动受限和斜颈2 d入院。查体,躯干部可见红色斑丘疹,颈部淋巴结肿大,结膜充血,口唇红,杨梅舌,手足硬肿,血常规中白细胞总数和C反应蛋白(CRP)明显升高,病程第20天四肢末端出现典型膜状脱皮,明确诊断为川崎病。患儿入院时伴有颈部活动受限和斜颈,影像学检查提示鼻咽和口咽右侧咽旁间隙肿物,给予抗生素及退热对症治疗无效,应用丙种球蛋白和阿司匹林治疗后,患儿颈部活动受限和斜颈表现消失,川崎病症状体征好转,实验室检查炎性指标逐渐恢复正常,复查颈部MRI提示咽旁间隙炎性改变较前明显减小。结论:头颈部异常表现可以作为川崎病的早期症状出现,易误诊为化脓性淋巴结炎或咽旁及咽后部化脓性感染。川崎病并发咽旁间隙或者咽后间隙炎性改变应尽早进行正确诊断和治疗,避免出现心血管系统损害以及行不必要的手术治疗。

Objective:To explore the clinical characteristics,diagnosis,treatment and prognosis of the children with Kawasaki disease complicated with inflammatory changes in parapharyngeal space and retropharyngeal space,and to improve the clinicians’understanding of the disease.Methods:The clinical data of one case of Kawasaki disease complicated with parapharyngeal space involvement as the main manifestation hospitalized in our department in November 2019 were retrospectively analyzed,and the clinical manifestations and imaging characteristics of Kawasaki disease complicated with head and neck symptoms were analyzed by reviewing and summarizing the previous literatures.Results:The male 3-year old patient had fever for 8 d,and was hospitalized due to neck movement limitation and torticula for 2 d.The physical examination results showed that there were red macular papules on the trunk,swollen lymph nodes on the neck,conjunctival hyperemia,red lips,waxberry tongue,and hard swelling of hands and feet.The total number of white blood cells and C-reactive protein(CRP)in blood routine examination were significantly increased.On the 20th day of the course of disease,typical membranous desquamation appeared in the extremities of the patient,which was clearly diagnosed as Kawasaki disease.The children had neck movement limitation and torticollis on admission,and the imaging results suggested a mass in the right parapharyngeal space of nasopharynx and oropharynx.The symptomatic treatment of the patient was ineffective after given antibiotics and antipyretic.After treatment with gamma globulin and aspirin,the neck movement limitation and torticula of the patient disappeared,the symptoms and signs of Kawasaki disease were improved,and the inflammatory indicators of laboratory examination were gradually returned to normal,and the neck MRI results showed that the inflammatory range of parapharyngeal space was significantly smaller than before.Conclusion:The abnormal manifestations of head and neck can be presented as early manifestations of Kawasaki disease,which is easily misdiagnosed as suppurative lymphadenitis or parapharyngeal and retropharyngeal suppurative infection.Kawasaki disease complicated with parapharyngeal space or retropharyngeal space inflammation should be correctly diagnosed and treated as soon as possible to avoid the cardiovascular system damage and unnecessary surgical treatment.