Beyond the abscess: Node-first Kawasaki disease mimicking deep neck infection in two children – A case report with a proposed management algorithm for otolaryngologists

Node-first Kawasaki disease (NFKD) is a phenotype in which cervical lymphadenopathy precedes other diagnostic criteria, frequently mimicking deep neck infection, and it remains under- recognised among otolaryngologists, who tend to diagnose it later than paediatricians. We present two children (a 7-month-old boy and a 2.5-year-old girl) admitted to the Department of Otolaryngology with suspected suppurative lymphadenitis. In both cases, ultrasonography excluded abscess formation, antibiotic therapy proved ineffective, and a notable CRP–procalcitonin (C-reactive protein–procalcitonin) dissociation (CRP >240 mg/L with PCT <0.5 ng/mL) was observed. Incomplete Kawasaki disease (KD) was diagnosed after paediatric consultation, and both patients responded promptly to intravenous immunoglobulin (IVIG). Follow-up over approximately 2 years showed no coronary abnormalities. Raising awareness of NFKD in otolaryngology training and applying a stepwise management algorithm may prevent unnecessary surgery and reduce coronary complications.