Hoarseness associated with early Kawasaki disease diagnosis
Hoarseness is a presenting sign in children with Kawasaki disease, according to recent study findings.
“Several lines of evidence suggest a respiratory portal of entry for the agent that triggers [Kawasaki disease] in genetically susceptible children,” researchers wrote. “These include presentation with enlarged anterior cervical lymph nodes that drain the posterior pharynx in 30% of patients, retropharyngeal edema imaged by computed tomography, and occasional reports of pulmonary nodules during the acute phase of the illness.”
The study, published in The Pediatric Infectious Disease Journal, included 287 pediatric patients with complete acute Kawasaki disease admitted to Rady Children’s Hospital, San Diego, from Jan. 1, 2007, to Aug. 31, 2011.
Shelby C. Leuin
Shelby C. Leuin, MD, and colleagues detected new onset hoarseness in 30% of participants (95% CI, 24.7-35.6). Participants with hoarseness were significantly younger compared with those without (1.9 vs. 3.1 years, respectively), presented earlier in the illness (day 5 vs. day 6), and had a higher absolute band count (1845 vs. 1341).
Of participants without hoarseness, 21.4% had a respiratory screen, five were positive: two with adenovirus, one with parainfluenza, and two with respiratory syncytial virus. However, only 18.6% of participants with hoarseness were screened and only one was positive for RSV. All hoarseness was resolved at the 2-week outpatient visit, according to the study results.
Three participants with hoarseness underwent flexible fiberoptic laryngoscopy and all had significant erythema and edema of the supraglottic structures. Edema of the vocal folds was present in two and one had small anterior vocal fold nodules compared with normal subjects of similar age.
“Our finding that hoarseness was associated with earlier diagnosis and higher band count in a subset of acute [Kawasaki disease] patients suggests that hoarseness may be a result of more severe systemic inflammation that also involves the larynx,” researchers wrote. “Possible mechanisms for the hoarseness include transient inflammation of the larynx with associated edema of the true vocal folds, the development of vocal fold nodules, and temporary recurrent laryngeal nerve paresis.”
Disclosure: The study was funded in part by The Hartwell Foundation; NIH; National, Heart, Lung, Blood Institute; and The Robert Wood Johnson Foundation.