Clinical features of atlantoaxial rotatory fixation among children with Kawasaki disease

More than 50% of Kawasaki disease patients exhibit cervical lymphadenopathy, which can lead to atlantoaxial rotatory fixation (AARF). Yet, the incidence and clinical features of AARF in Kawasaki disease (KD-AARF) have been poorly documented. This study explored the symptomatic incidence of AARF in patients with Kawasaki disease. Data were retrospectively collected from 1296 consecutive patients (740 male and 556 female) diagnosed with Kawasaki disease between April 2005 and March 2022 at a single academic institution. Fourteen (six males and eight females) of 1296 Kawasaki disease cases (1.08%) were diagnosed with AARF. The median and interquartile range (IQR) age (month) of KD-AARF was 60.0 months (IQR: 42.5–84.8 months), and the median age of Kawasaki disease without AARF was 28.0 months (IQR: 14.0–28.3 months) ( P < 0.001). The average (range) symptomatic duration of torticollis was 16.0 (5–43) days. Moreover, seven cases were treated only with bed rest, one case with bed rest and analgesics, three with a cervical collar, and three using Glisson’s traction. At the final follow-up (average: 35.5 months), none of the patients exhibited any residual symptoms. The average time from fever onset to torticollis onset was 2.9 (0–7) days, and that from fever resolution to torticollis resolution was 13.4 (4–41) days. The total treatment duration for KD-AARF was 16.4 ± 12.6 days. AARF incidence in Kawasaki disease cases was 1.08%. Patients with KD-AARF were older than those without.