Lack of association of cervical lymphadenopathy and coronary artery complications in Kawasaki disease

Abstract

Background: Cervical lymphadenopathy is a typical feature in some children with Kawasaki disease, but whether its presence or absence delays diagnosis, thereby increasing the risk of coronary artery abnormalities, has remained uncertain.

Aim: : The aim of this study is to review the clinical features of Kawasaki disease with particular reference to investigating the relationship of cervical lymphadenopathy to the development of coronary artery lesions.

Methods: Demographic and clinical data from all the patients entered into the Hong Kong Kawasaki disease registry during 1994 to 2000 were reviewed. The presenting clinical features, echocardiographically monitored coronary artery lesions and influence of cervical lymphadenopathy (> or = 1 nodes > or = 1.5 cm diameter) on clinical onset-to-diagnosis time and response to immunoglobulin therapy are reported.

Results: We studied 696 patients (99% Chinese, male/female ratio 1.7:1). Their distribution was inversely related to age. Twenty-four percent of the patients presented with cervical lymphadenopathy, the relative incidence of which was directly related to age. Five percent of patients had demonstrable coronary artery aneurysms at 8 weeks after disease onset. A slightly higher percentage of patients with absence of lymphadenopathy had late diagnosis. No significant positive or negative overall association between cervical lymphadenopathy and coronary artery lesions was observed. Time to resolution of fever after immunoglobulin administration did not differ between those with and without cervical lymphadenopathy.

Conclusions: Cervical lymphadenopathy was present in only 24% of the patients with Kawasaki disease, correlating directly with age. Its absence may delay the timing of diagnosis. There was, however, no overall association between lymphadenopathy and coronary lesions.