“Unusual” course of lymphadenopathy in patients with Kawasaki disease: clinical case and literature data

Abstract

Kawasaki disease is an acute febrile illness of childhood, one of its characteristic features is lymphadenopathy. Most often it manifests unilateral painful more than 1.5 sm in diameter enlargement of single or several cervical lymph nodes. In some cases increase in size can be observed in other lymph nodes groups: axillary, inguinal, paratracheal, para-aortic, retroperitoneal, mesenteric. In that case the dimension is smaller than 1.5 sm in diameter. Usually it occurs at the same time as fever and fades away after inflammation is terminated. Most typical morphological features are non-purulent necrotic changes with subcapsular necrotic lesions and non-specific changes: presence of enlargement of paracortical zone and expansion of sinus. The article presents a clinical case of Kawasaki disease diagnosis accompanied by severe lymphadenopathy, persistence of fever and progression of lymphadenopathy, appearance of supraclavicular lymph node after the introduction of intravenous immunoglobulin. This reflects the non-smooth course of the disease and required differential diagnosis, primarily with lymphoproliferative disease. A review of “unusual” cases of lymphadenopathy in patients with Kawasaki disease described in the literature is presented. The importance of carrying out a histological examination of the lymph node in a nonsmooth course of the disease is underlined. Histological variants of lymph node involvement in patients with Kawasaki disease are described.