Abstract
BACKGROUND: Kawasaki disease (KD), also known as mucocutaneous lymph node syndrome, is an acute febrile exanthematous illness primarily affecting children under 5 years of age. It is characterized by systemic vasculitis of medium and small arteries. KD can present with cervical lymphadenopathy and fever as initial symptoms, often making it difficult to distinguish from acute bacterial lymphadenitis, parapharyngeal abscess or other cervical cystic lesions. CASE PRESENTATION: This study reports the case of a 6-year-old child presenting with a fever and a neck mass. The patient was initially diagnosed with acute lymphadenitis with a parapharyngeal abscess, and was subsequently admitted for surgery, at which point computed tomography (CT) revealed a cystic lesion in the neck. Despite neck surgery, the child experienced persistent unexplained fevers. Lymph node biopsy indicated necrotizing lymphadenitis, and pathogen gene sequencing was negative for specific infections. During the disease course, the child developed conjunctival injection, strawberry tongue, and rash. After a thorough examination, the child was ultimately diagnosed with lymphadenopathy-first-presenting KD, with CT showing multiple cystic lesions in the soft tissues. Treatment with high-dose immunoglobulin and aspirin resulted in the rapid resolution of fever and other KD symptoms. A 2-year follow-up showed no recurrence or coronary artery abnormalities. CONCLUSION: In this child presenting with fever and neck masses, CT revealed multiple cystic lesions in soft tissues. This experience suggests that careful examination and evaluation before and after neck abscess surgery are crucial to avoid misdiagnosis and unnecessary surgical trauma.