临床儿科杂志 ›› 2020, Vol. 38 ›› Issue (12): 912-.doi: 10.3969/j.issn.1000-3606.2020.12.008

• 呼吸系统疾病专栏 • 上一篇    下一篇

以咽旁间隙炎症为主要表现的不完全川崎病1例报告并文献复习

毛雨鸽,孙燕,张清友   

  1. 北京大学第一医院儿科(北京 100034)
  • 出版日期:2020-12-15 发布日期:2020-12-18
  • 通讯作者: 张清友 电子信箱:zhangqingyou_73@126.com

Incomplete Kawasaki disease with parapharyngeal space inflammation as the main manifestation: a case report and literature review

MAO Yuge, SUN Yan, ZHANG Qingyou   

  1. Department of Pediatrics, Peking University First Hospital, Beijing 100035 , China
  • Online:2020-12-15 Published:2020-12-18

摘要: 目的 探讨以咽旁间隙炎症为主要表现的不完全川崎病(KD)的临床特征及诊疗。方法 回顾分析2019年 12月收治的1例主要表现为咽旁间隙炎症的KD患儿的临床资料,并进行文献复习。结果 患儿男性,6岁。发热9天,颈 部疼痛伴淋巴结肿大,躯干部少许皮疹。C反应蛋白及红细胞沉降率显著升高,予对症退热及抗生素治疗无效。超声心动 图示左冠状动脉轻度扩张。颈部MRI示咽旁间隙炎症。患儿予大剂量丙种球蛋白、阿司匹林治疗后,体温恢复正常,颈部 红肿疼痛消失,炎症指标逐渐降至正常。复查颈部MRI示病灶较前减小,同时在病程14天患儿手指甲床出现典型的皮肤 移行处的膜样脱皮。确诊为不完全KD。共检索到外文文献40篇,报道200余例,中文文献1篇,报道1例。结论 以咽后 壁或咽旁间隙炎症为首发表现的KD少见,临床需尽早评估和治疗。

关键词: 川崎病; 咽旁间隙; 炎症

Abstract: Objective To explore the clinical features, diagnosis and treatment of incomplete Kawasaki disease (KD) with parapharyngeal space inflammation as the main manifestation. Methods The clinical data of a KD patient with parapharyngeal space inflammation admitted in December 2019 were retrospectively analyzed, and literature review was conducted. Results A 6 -year-old boy presented with fever for 9 days. He had neck pain with enlarged lymph nodes and a few skin rashes in the trunk. C-reactive protein and erythrocyte sedimentation rate were significantly increased, and antipyretic and antibiotic treatment was not effective. The echocardiography showed a slight dilation of the left coronary artery. Neck MRI showed inflammation of the parapharyngeal space. After the treatment with high-dose gamma globulin and aspirin, the boy's body temperature returned to normal, the swelling and pain of the neck disappeared, and the inflammation index gradually decreased to normal. Reexamination of neck MRI showed that the lesion was smaller than before, and the typical membranous peeling of skin transition occurred in the fingernail bed of the child on the 14th day. Diagnosis of incomplete KD was confirmed. A total of 40 foreign literatures were retrieved and more than 200 cases were reported. One Chinese literature was retrieved and one case was reported. Conclusion? KD with inflammation of the posterior pharyngeal wall or parapharyngeal space as the first manifestation is rare and requires early clinical evaluation and treatment.

Key words: Kawasaki disease;? parapharyngeal space;? inflammation