Kawasaki-Erkrankung bei einem 13 jahrigen Jungen mit ausgepragter unilateraler zervikaler Lymphadenopathie und Polyarthritis

A 13-year-old male adolescent suddenly developed unilateral cervical lymphadenopathy which resulted in the excision of the enlarged lymph nodes. After the intervention his general state deteriorated and the patient was transferred to our hospital. The patient presented with high fever, bilateral non-purulent conjunctivitis, strawberry tongue and fissured lips, a maculopapular rash and severe polyarthritis including all peripheral joints. We treated him for Kawasaki disease with single high-dose intravenous gamma- globulin. Within 16 hours he became afebrile and all other symptoms disappeared rapidly. A few days later, he developed thrombocytosis and desquamation of the tips of fingers and toes. The immunohistological examination of the lymph nodes demonstrated interfollicular hyperplasia of the T-zones and in the peripheral blood an expansion of the Vβ2-positive T- cell subset was found. These findings support recent aspects concerning the pathogenesis of Kawasaki disease. Discussion: Although Kawasaki disease is mainly observed in preschoolchildren, older children and adolescents may be affected. Extreme forms of cervical lymphadenopathy may occur and in the case of a strictly unilateral lymphadenopathy the diagnosis may be difficult.