Acute nonsuppurative transient cervical lymphadenopathy

Introduction Acute non-suppurative transient cervical lymph node swelling, typical Kawasaki disease signs, the most prominent neck, diameter of about 1.5cm or more, mostly appear in one side, slightly tender, occurred within 3 days after fever, a few days later More.

Cause

The cause is not yet clear. The disease is a certain epidemic and landlord, the clinical manifestations of fever, rash, etc., presumably related to infection. It is generally believed to be a variety of pathogens, including Epstein-Barr virus, retrovirus, or Streptococcus, Propionibacterium infection. In 1986, the activity of reverse transcriptase in peripheral blood lymphocyte culture supernatants was reported to increase, suggesting that the disease may be caused by retrovirus. However, most studies did not achieve consistent results. In the past, it has been suggested that mycoplasma, rickettsia, and dust mites are the pathogens of this disease and have not been confirmed. Some people think that environmental pollution or chemical allergy may be the cause of the disease.

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The main symptoms are common persistent fever, 5 to 11 days or longer (2 weeks to 1 month), body temperature often reaches 39 ° C or more, antibiotic treatment is invalid. Common bilateral conjunctival congestion, lip flushing, cleft palate or bleeding, see the bayberry-like tongue. Hard edema in the hands, flushing of the palms and soles of the feet early, 10 days after the emergence of characteristic toe-end large-scale peeling, appearing at the junction of the nail bed skin. There is also an acute non-suppurative transient cervical lymph node swelling, the most prominent neck, the diameter of about 1.5cm or more, mostly appear in one side, slightly tenderness, occurred within 3 days after fever, and self-healing after a few days. Shortly after fever (about 1-4 days), there is a maculopapular rash or a polymorphous erythematous rash. Occasionally, a herpes-like rash is more common in the trunk, but no herpes and crusting, and it subsides in about a week.

Other symptoms often present with heart damage, symptoms of myocarditis, pericarditis, and endocarditis. The patient's pulse is accelerated, and the tachycardia, galloping, and low-pitched heart sounds can be heard during auscultation. Systolic murmurs are also more common. Valve insufficiency and heart failure can occur. For echocardiography and coronary angiography, most patients have coronary aneurysms, pericardial effusion, left ventricular enlargement, and mitral regurgitation. The X-ray chest showed visible enlargement of the heart. Occasionally joint pain or swelling, cough, runny nose, abdominal pain, mild jaundice or aseptic cerebrospinal meningitis. In the acute phase, about 20% of cases have perineal, perianal skin flushing and desquamation, and erythema or scarring is reproduced in the original site of BCG vaccination 1 to 3 years ago. During the recovery period, the nail can be seen in the transverse groove.

Different lengths. The first phase of the disease course is acute fever, and the general course of disease is 1 to 11 days. The main symptoms appear after fever, and severe myocarditis can occur. Entering the second phase is the subacute phase, which usually lasts for 11 to 21 days. Most of the body temperature decreases, the symptoms are relieved, and membranous peeling occurs at the toe end. Severe cases still have a fever. Coronary aneurysms can cause myocardial infarction and rupture of aneurysms. Most patients enter the third phase, the recovery period, at the fourth week, usually 21 to 60 days, and the clinical symptoms subsided. If there is no obvious coronary artery disease, it will gradually recover. Coronary aneurysm is still sustainable, and myocardial can occur. Infarction or ischemic heart disease. A small number of patients with severe coronary aneurysms enter the chronic phase, can be prolonged for several years, left coronary artery stenosis, angina pectoris, cardiac insufficiency, ischemic heart disease, can be life-threatening due to myocardial infarction.

The Japanese MCLS Research Committee (1984) proposed that the diagnostic criteria for this disease should be determined by satisfying at least five of the following six major clinical symptoms:

1. Unexplained fever for 5 days or longer.

2, bilateral conjunctival congestion.

3, oral and pharyngeal mucosa diffuse congestion, red lips and chapped, and is Yangmei tongue.

4. In the early stage of the disease, the hand and foot are swollen and the palmar sputum is red, and the membranous peeling occurs at the toe end during the recovery period.

5, the body is multi-shaped erythema, but no blistering and crusting.

6. Non-suppurative swelling of the cervical lymph nodes, the diameter of which is 1.5 cm or more. However, if two-dimensional echocardiography or coronary angiography is used to detect coronary aneurysms or dilatation, the four main symptoms can be confirmed.

Differential diagnosis

It should be differentiated from various rash infectious diseases, viral infections, acute lymphadenitis, rheumatoid diseases and other connective tissue diseases, viral myocarditis, rheumatoid carditis.

The difference between this disease and scarlet fever is:

1. The rash begins on the third day after the onset of the disease.

2. The rash morphology is close to measles and polymorphic erythema.

3, the age of good hair is the period of infants and young children.

4, penicillin no effect.

The difference between this disease and juvenile rheumatoid disease is:

1. The fever period is shorter and the rash is shorter.

2, the hands and feet are hard and swollen, showing frequent flushing.

3. The rheumatoid factor is negative.

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