لنفادنيت گردني مقاوم به درمان در كودك 10 ساله: گزارش موردي

Resistant cervical lymphadenitis in a 10-year-old child: case report

فرد مبتلا به لنفادنيت گردني چركي با تظاهراتي ازجمله تب مراجعه و نياز به درمان آنتي بيوتيكي دارد. در صورت عدم پاسخ به درمان مي بايست علل ديگر از جمله موارد عفوني غير شايع، بدخيمي و كاوازاكي را در نظر داشت. هدف اين مطالعه معرفي كودكي با شك به لنفادنيت گردني چركي بود كه در نهايت تشخيص كاوازاكي داده شد. معرفي بيمار: بيمار پسر 10 ساله كه با تب و لنفادنيت شديد گردني، به بيمارستان مركز طبي كودكان تهران در ارديبهشت 1397 مراجعه كرد و تحت درمان آنتي بيوتيكي قرار گرفت. با توجه به عدم پاسخ به درمان، ادامه تب، افزايش ESR و بروز آرترالژي، براي بيمار اكوكارديوگرافي به عمل آمد كه اكتازي عروق كرونر مشاهده شد (LAD>2/5 SD) و با تشخيص كاوازاكي درمان شد كه به صورت دراماتيك به درمان پاسخ داد. نتيجه گيري: بيماري كاوازاكي يكي از علل لنفادنيت گردني مي باشد كه در صورت عدم پاسخ لنفادنيت چركي گردن به آنتي بيوتيك، مي بايست مدنظر قرار گيرد.

Purulent cervical lymphadenitis presents with different manifestations such as fever and Erythema of the skin at the site of infection. The appropriate treatment for purulent lymphadenitis are antibiotics. If there is no response to antibiotic treatment, other causes should be considered, including uncommon infectious causes (for example Mycobacterium infections or fungal infections), malignancy and Kawasaki diseases, etc. This study aimed to introduce a child with suspected purulent cervical lymphadenitis, who was initially presented with purulent lymphadenitis and was treated with broad-spectrum antibiotics. Due to the lack of response to treatment, further laboratory and clinical examinations were performed for him, then he was diagnosed with Kawasaki disease. Case Presentation A 10-year-old boy with fever and severe cervical lymphadenitis was referred to Tehran Childrenchr('39')s Medical Center Hospital in May 2018. He had leukocytosis in his lab test and the acute reactant phase was high. He was diagnosed with purulent lymphadenitis and he was treated with broad-spectrum antibiotics. But no therapeutic response was observed, the patientchr('39')s fever continued and erythrocyte sedimentation rate (ESR) increased in the laboratory tests. The patientchr('39')s knee developed arthralgia, and Inflammation of the neck spread to the chest wall. Therefore echocardiography was performed. The patientchr('39')s left anterior descending artery (LAD) had ectasia in echocardiography (LAD>2/5 SD). The patient was diagnosed with atypical Kawasaki disease, therefore the appropriate treatment was started for him and a dramatic clinical response was seen. His fever stopped and the patientchr('39')s cervical lymphadenitis had completely improved. In the follow-up, the patientchr('39')s left anterior descending artery (LAD) ectasia was resolved. Conclusion Kawasaki disease is one of the causes of cervical lymphadenitis in children. If a patient with suspected purulent lymphadenitis is treated with appropriate antibiotics but no adequate response is seen, Kawasaki disease should be considered and the patient must be re-evaluated for Kawasaki disease.