Atypical presentation of Kawasaki disease resembling a retropharyngeal abscess / 소아과

Kawasaki disease is an acute systemic inflammatory disorder, the etiology of which has not yet been established. The clinical manifestations are non-specific and are common to many pediatric infectious and immunologic diseases. In 2 cases presenting fever, cervical lymphadenopathy, and retropharyngeal abscess-like lesions on the neck shown in a computerized tomography (CT) scan, the diagnosis of Kawasaki disease was delayed. The patients were not responsive to antibiotic therapy, and fluid collection was not found during retropharyngeal aspiration. They showed typical Kawasaki manifestations over time and atrioventricular valve regurgitation in the echocardiogram. A diagnosis of Kawasaki disease should be considered in similar cases of fever and cervical lymphadenopathy. A CT scan that shows a retropharyngeal abscess-like lesion on the neck can be a false positive finding, and other laboratory exams, including echocardiography, should be performed as early as possible to avoid unnecessary medical and surgical procedures.

A case of successful treatment of stroke with intracardiac thrombi in a patient with severe ovarian hyperstimulation syndrome / 대한산부인과학회지

Thromboembolism is a rare complication of ovarian hyperstimulation syndrom (OHSS). According to the numerous reports, it most commonly occurs in upper extremities, head, and neck vein. It is also well known that acute cerebral infarction, once occurred, is mainly caused by the occlusion of large arteries, especially middle cerebral artery (MCA) in most cases. Administration of heparin has been considered as the best treatment option, but many studies have been reporting successful treatment results from administrating thrombolytics in patients with cerebral infarction. Although administration of thrombolytics is invasive and has some potential side effects including bleeding or hematoma, it still has been used for treating patients with cerebral infarction. We report a case of patient with intracardiac thrombi and manifested symptoms of acute cerebral infarction originally caused by OHSS followed by the occlusion of MCA. We administered thrombolytics within one and half hours of showing left hemiparesis caused by the occlusion of right MCA, and identified reperfusion of MCA. There was no evidence of complications associated with the administration of thrombolytics on CT scan, which was taken 24 hours later. Thrombi in IVC, right atrium, and right ventricle were found on chest CT with pleural effusion, but soon were disappeared after administrating heparin anticoagulation. We report this case to show that thrombolytics and anticoagulation can be safely used to treat a patient with cerebral infarction and thrombi caused by OHSS without any side effects or complications.