Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Uveitis as an important ocular sign to help early diagnosis in Kawasaki disease

  • Choi, Han Seul (Department of Pediatrics, Ewha Womans University School of Medicine) ;
  • Lee, Seul Bee (Department of Pediatrics, Ewha Womans University School of Medicine) ;
  • Kwon, Jung Hyun (Department of Pediatrics, Ewha Womans University School of Medicine) ;
  • Kim, Hae Soon (Department of Pediatrics, Ewha Womans University School of Medicine) ;
  • Sohn, Se Jung (Department of Pediatrics, Ewha Womans University School of Medicine) ;
  • Hong, Young Mi (Department of Pediatrics, Ewha Womans University School of Medicine)
  • Received : 2014.12.29
  • Accepted : 2015.04.01
  • Published : 2015.10.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Incomplete Kawasaki disease (KD) is frequently associated with delayed diagnosis and treatment. Delayed diagnosis leads to increasing risk of coronary artery aneurysm. Anterior uveitis is an important ocular signs of KD. The purpose of this study was to assess differences in laboratory findings, including echocardiographic measurements, clinical characteristics such as fever duration and treatment responses between KD patients with and those without uveitis. Methods: We conducted a prospective study with 110 KD patients from January 2008 to June 2013. The study group (n=32, KD with uveitis) was compared with the control group (n=78, KD without uveitis). Laboratory data were obtained from each patient including complete blood count (CBC), erythrocyte sedimentation rate (ESR), platelet count, and level of alanine aminotransferase, aspartate aminotransferase, serum total protein, albumin, C-reactive protein (CRP), and N-terminal probrain natriuretic peptide (NT-pro BNP). Echocardiographic measurements and intravenous immunoglobulin responses were compared between the two groups. Results: The incidence of uveitis was 29.0%. Neutrophil counts and patient age were higher in the uveitis group than in the control group. ESR and CRP level were slightly increased in the uveitis group compared with the control group, but the difference between the two groups was not significant. No significant differences in coronary arterial complication and treatment responses were observed between the two groups. Conclusion: Uveitis is an important ocular sign in the diagnosis of incomplete KD. It is significantly associated with patient age and neutrophil count.

Keywords

References

  1. Gerding R. Kawasaki disease: a review. J Pediatr Health Care 2011; 25:379-87. https://doi.org/10.1016/j.pedhc.2011.07.007
  2. Kim JJ, Hong YM, Yun SW, Han MK, Lee KY, Song MS, et al. Assessment of risk factors for Korean children with Kawasaki disease. Pediatr Cardiol 2012;33:513-20. https://doi.org/10.1007/s00246-011-0143-1
  3. Eleftheriou D, Levin M, Shingadia D, Tulloh R, Klein NJ, Brogan PA. Management of Kawasaki disease. Arch Dis Child 2014;99:74-83. https://doi.org/10.1136/archdischild-2012-302841
  4. Kim DS. Kawasaki disease. Yonsei Med J 2006;47:759-72. https://doi.org/10.3349/ymj.2006.47.6.759
  5. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Pediatrics 2004;114:1708-33. https://doi.org/10.1542/peds.2004-2182
  6. Freeman AF, Shulman ST. Kawasaki disease: summary of the American Heart Association guidelines. Am Fam Physician 2006; 74:1141-8.
  7. Yu JJ. Diagnosis of incomplete Kawasaki disease. Korean J Pediatr 2012;55:83-7. https://doi.org/10.3345/kjp.2012.55.3.83
  8. Sonobe T, Kiyosawa N, Tsuchiya K, Aso S, Imada Y, Imai Y, et al. Prevalence of coronary artery abnormality in incomplete Kawasaki disease. Pediatr Int 2007;49:421-6. https://doi.org/10.1111/j.1442-200X.2007.02396.x
  9. Ohno S, Miyajima T, Higuchi M, Yoshida A, Matsuda H, Saheki Y, et al. Ocular manifestations of Kawasaki's disease (mucocutaneous lymph node syndrome). Am J Ophthalmol 1982;93:713-7. https://doi.org/10.1016/0002-9394(82)90465-2
  10. Burns JC, Joffe L, Sargent RA, Glode MP. Anterior uveitis associated with Kawasaki syndrome. Pediatr Infect Dis 1985;4:258-61. https://doi.org/10.1097/00006454-198505000-00010
  11. Guney E, Tugal-Tutkun I. Symptoms and signs of anterior uveitis. US Ophthalmic Rev 2013;6:33-7. https://doi.org/10.17925/USOR.2013.06.01.33
  12. Jabs DA, Nussenblatt RB, Rosenbaum JT; Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol 2005;140:509-16. https://doi.org/10.1016/j.ajo.2005.03.057
  13. JCS Joint Working Group. Guidelines for diagnosis and management of cardiovascular sequelae in Kawasaki disease (JCS 2008)--digest version. Circ J 2010;74:1989-2020. https://doi.org/10.1253/circj.CJ-10-74-0903
  14. Sundel RP. Kawasaki disease. Rheum Dis Clin North Am 2015;41: 63-73. https://doi.org/10.1016/j.rdc.2014.09.010
  15. Bayers S, Shulman ST, Paller AS. Kawasaki disease: part I. Diagnosis, clinical features, and pathogenesis. J Am Acad Dermatol 2013;69:501.e1-11.
  16. Agrawal RV, Murthy S, Sangwan V, Biswas J. Current approach in diagnosis and management of anterior uveitis. Indian J Ophthalmol 2010;58:11-9. https://doi.org/10.4103/0301-4738.58468
  17. BenEzra D, Cohen E, Maftzir G. Uveitis in children and adolescents. Br J Ophthalmol 2005;89:444-8. https://doi.org/10.1136/bjo.2004.050609
  18. Klig JE. Ophthalmologic complications of systemic disease. Emerg Med Clin North Am 2008;26:217-31. https://doi.org/10.1016/j.emc.2007.10.003
  19. Kump LI, Cervantes-Castaneda RA, Androudi SN, Foster CS. Analysis of pediatric uveitis cases at a tertiary referral center. Ophthalmology 2005;112:1287-92. https://doi.org/10.1016/j.ophtha.2005.01.044
  20. Anesi SD, Foster CS. Anterior uveitis: etiology and treatment. Advanced Ocular Care 2011;Jan/Feb:32-4.
  21. Barone SR, Pontrelli LR, Krilov LR. The differentiation of classic Kawasaki disease, atypical Kawasaki disease, and acute adenoviral infection: use of clinical features and a rapid direct fluorescent antigen test. Arch Pediatr Adolesc Med 2000;154:453-6. https://doi.org/10.1001/archpedi.154.5.453
  22. Dahdah N, Siles A, Fournier A, Cousineau J, Delvin E, Saint-Cyr C, et al. Natriuretic peptide as an adjunctive diagnostic test in the acute phase of Kawasaki disease. Pediatr Cardiol 2009;30:810-7. https://doi.org/10.1007/s00246-009-9441-2
  23. Kawamura T, Wago M, Kawaguchi H, Tahara M, Yuge M. Plasma brain natriuretic peptide concentrations in patients with Kawasaki disease. Pediatr Int 2000;42:241-8. https://doi.org/10.1046/j.1442-200x.2000.01225.x

Cited by

  1. Kawasaki Disease with Optic Disc Swelling and Uveitis vol.39, pp.4, 2015, https://doi.org/10.12771/emj.2016.39.4.133
  2. Changes in clinical and laboratory features of Kawasaki disease noted over time in Daejeon, Korea vol.15, pp.1, 2017, https://doi.org/10.1186/s12969-017-0192-y
  3. Diagnosis of Kawasaki disease vol.21, pp.1, 2015, https://doi.org/10.1111/1756-185x.13224
  4. Clinical implications in laboratory parameter values in acute Kawasaki disease for early diagnosis and proper treatment vol.61, pp.5, 2015, https://doi.org/10.3345/kjp.2018.61.5.160
  5. Kawasaki disease: characteristics, diagnosis, and unusual presentations vol.15, pp.10, 2019, https://doi.org/10.1080/1744666x.2019.1659726
  6. Paediatric autoimmune and autoinflammatory conditions associated with uveitis vol.12, pp.None, 2020, https://doi.org/10.1177/2515841420966451
  7. Subconjunctival Acute Bilateral Hemorrhages Due to Kawasaki Disease in a Costa Rican Girl: An Unusual Clinical Manifestation of the Disease vol.12, pp.9, 2015, https://doi.org/10.7759/cureus.10212
  8. Relationship between ocular involvement and clinical manifestations, laboratory findings, and coronary artery dilatation in Kawasaki disease vol.34, pp.10, 2020, https://doi.org/10.1038/s41433-019-0762-y
  9. Bilateral Acute Anterior Uveitis and Corneal Punctate Epitheliopathy in Children Diagnosed with Multisystem Inflammatory Syndrome Secondary to COVID‐19 vol.29, pp.4, 2015, https://doi.org/10.1080/09273948.2021.1909070