Introduction:

Kawasaki disease (KD) is one of the most common vasculitides in childhood and may cause serious complications, namely coronary artery aneurism (CAA). KD may initially present with fever and otorhinolaryngological manifestations only, which may be misdiagnosed as deep neck infections.

Case report:

A four-year-old female was admitted for complicated acute tonsillitis. Cervical computed tomography suggested an early retropharyngeal abscess. She received intravenous antibiotics and underwent two surgical procedures, without improvement. On day ten of fever, non-specific generalized rash and hand edema were noted, raising suspicion of incomplete KD. Echocardiogram revealed CAA. The girl was treated with intravenous immunoglobulin and corticosteroids, with clinical and laboratory improvement and CAA rapid and persistent resolution.

Discussion:

Suspected complicated tonsillitis failing to respond to adequate treatment should raise suspicion of KD. Prompt treatment is critical to reducing cardiovascular sequelae. Two to three clinical criteria with supplemental laboratory criteria or a positive echocardiogram confirm the diagnosis of incomplete KD.

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