Abstract
OBJECTIVES: Cervical lymphadenopathy (CL) is a significant but underexplored feature of Kawasaki disease (KD), especially during its early stages. Although CL is a recognized diagnostic criterion for KD, it is frequently misdiagnosed as bacterial cervical lymphadenitis (BCL). This study aimed to investigate the clinical and imaging characteristics of CL in KD, particularly in cases, where KD initially presents with fever and cervical lymphadenopathy (LKD). The study also focused on differentiating LKD from BCL and examining its association with systemic and cervical complications. METHODS: In this study, 681 KD patients and 101 BCL patients hospitalized at the Yuying Children's Hospital affiliated with Wenzhou Medical University from January 1, 2021, to October 1, 2023, were enrolled. Among the KD patients, 403 exhibited cervical lymphadenopathy, including 86 who presented only with fever and cervical lymphadenopathy upon admission (LKD group), 317 who displayed typical features of cervical lymphadenopathy (Other KD group), and 243 who did not exhibit cervical lymphadenopathy. Demographic, clinical, laboratory, and imaging data were compared across these groups to identify distinguishing characteristics and potential complications. RESULTS: The findings indicated that patients with CL in KD were younger than those with BCL, experienced a longer duration of fever prior to treatment, and exhibited more severe inflammatory responses and liver abnormalities. KD patients with enlarged cervical lymph nodes were more likely to exhibit systemic involvement. Imaging studies revealed bilateral lymph node enlargement without liquefaction in KD, which contrasts with the abscess formation commonly observed in BCL. Compared to KD patients without lymphadenopathy, those with CL were older, more likely to present with conjunctival congestion, had higher neutrophil ratios, elevated liver damage markers, an increased rate of intravenous immunoglobulin (IVIG) resistance, and a higher incidence of KD shock syndrome (KDSS). Among these, LKD patients were older, nearly all reported neck pain, had a higher referral rate, elevated neutrophil counts and C-reactive protein (CRP) levels, and a higher prevalence of cervical complications, such as atlantoaxial subluxation and parotitis. Ultrasound examinations of cervical lymph nodes showed that the LKD group had larger diameters of enlarged lymph nodes, with the largest lymph node frequently found in the Level II region. CONCLUSIONS: IVIG resistance and KDSS are more prevalent among patients with cervical lymph node enlargement in Kawasaki disease compared to those without lymph node involvement. When cervical B-ultrasonography reveals bilateral multiple lymph nodes in Level II regions, without liquefaction or significant abscess formation, clinicians should be vigilant for the possibility of Kawasaki disease.