J Korean Ophthalmol Soc.  2016 Feb;57(2):296-301. 10.3341/jkos.2016.57.2.296.

Anterior Uveitis Associated with Kawasaki Disease-and the Ophthalmologist's Role

• Kim M
• Kim SY

• KMID: 2213672
• DOI: http://doi.org/10.3341/jkos.2016.57.2.296

Abstract

PURPOSE
To identify ophthalmologic features of Kawasaki disease (KD), and to evaluate anterior uveitis incidence in typical KD and atypical KD.
METHODS
We conducted a retrospective chart review of 60 patients who clinically suspected KD at The Catholic University of Korea Uijeongbu St. Mary's Hospital between October 2013 and January 2015.
RESULTS
Among a total of 60 patients, 46 were diagnosed with KD; 32 (69.57%) were typical KD and, 14 (30.43%) atypical KD. Anterior uveitis was reported in 69.57% of children with KD. Slit-lamp examination showed anterior chamber cells (average Standardization of Uveitis Nomenclature [SUN] grade 1.3) and the anterior uveitis fully resolved within 9.4 days after the onset of the disease. There was no significant difference in typical KD and atypical KD in terms of age, gender, or uveitis incidence.
CONCLUSIONS
KD may progress with severe cardiac complications, eventually resulting in permanent sequale. Therefore, early diagnosis and therapeutic intervention is important in KD patients. Anterior uveitis as diagnostic criteria for KD has yielded 100% positive predictive value, 69.6% sensitivity and 100% specificity. Ophthalmologic examination may be useful for suspected KD patients, and a high index of suspicion is necessary in patients with anterior uveitis.

Keyword

Kawasaki disease; Uveitis; Vasculitis

MeSH Terms

Anterior Chamber
Child
Early Diagnosis
Humans
Incidence
Korea
Mucocutaneous Lymph Node Syndrome
Retrospective Studies
Sensitivity and Specificity
Uveitis
Uveitis, Anterior*
Vasculitis

Reference

1). Kawasaki T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Arerugi. 1967; 16:178–222.

2). Matucci-Cerinic M, Furst D, Fiorentino D. Skin Manifestations in Rheumatic Disease. New York: Springer;2013. p. 283–8.

3). Mary BFS, Jane W. Kawasaki disease. Kliegman RM, Stanton B, Geme JS, editors. Nelson Textbook of Pediatrics. 20th ed.Philadelphia: Health Sciences;2015. chap. 166.

4). Naoe S, Shibuya K, Takahashi K, et al. Pathological observations concerning the cardiovascular lesions in Kawasaki disease. Cardiol Young. 1991; 1:212–20.

5). Dajani AS, Taubert KA, Gerber MA, et al. Diagnosis and therapy of Kawasaki disease in children. Circulation. 1993; 87:1776–80.

6). Rowley AH, Shulman ST. Kawasaki syndrome. Pediatr Clin North Am. 1999; 46:313–29.

7). Witt MT, Minich LL, Bohnsack JF, Young PC. Kawasaki disease: more patients are being diagnosed who do not meet American Heart Association criteria. Pediatrics. 1999; 104:e10.

8). Fukushige J, Takahashi N, Ueda Y, Ueda K. Incidence and clinical features of incomplete Kawasaki disease. Acta Paediatr. 1994; 83:1057–60.

9). Rowley AH, Gonzalez-Crussi F, Gidding SS, et al. Incomplete Kawasaki disease with coronary artery involvement. J Pediatr. 1987; 110:409–13.

10). Joffe A, Kabani A, Jadavji T. Atypical and complicated Kawasaki disease in infants. Do we need criteria? West J Med. 1995; 162:322–7.

11). Levy M, Koren G. Atypical Kawasaki disease: analysis of clinical presentation and diagnostic clues. Pediatr Infect Dis J. 1990; 9:122–6.

12). Nakamura Y, Yanagawa H, Kato H, Kawasaki T. Mortality rates for patients with a history of Kawasaki disease in Japan. Kawasaki Disease Follow-up Group. J Pediatr. 1996; 128:75–81.

13). Dajani AS, Taubert KA, Takahashi M, et al. Guidelines for long-term management of patients with Kawasaki disease. Report from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 1994; 89:916–22.

14). Newburger JW, Takahashi M, Burns JC, et al. The treatment of Kawasaki syndrome with intravenous gamma globulin. N Engl J Med. 1986; 315:341–7.

15). Burns JC, Joffe L, Sargent RA, Glode MP. Anterior uveitis associated with Kawasaki syndrome. Pediatr Infect Dis. 1985; 4:258–61.

16). Reller M, DeCristofaro J, Schwartz DC. Coronary aneurysms in a patient with atypical Kawasaki syndrome and a streptococcal infection. Pediatr Cardiol. 1984; 5:205–7.

17). Googe JM Jr, Brady SE, Argyle JC, et al. Choroiditis in infantile periarteritis nodosa. Arch Ophthalmol. 1985; 103:81–3.

18). 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.

19). Park YW, Han JW, Park IS. . Kawasaki disease in Korea, 2003-2005. Pediatr Infect Dis J. 2007; 26:821–3.

20). Yanagawa H, Nakamura Y, Yashiro M, et al. Incidence survey of Kawasaki disease in 1997 and 1998 in Japan. Pediatrics. 2001; 107:E33.

21). Kim DS. Kawasaki disease. Yonsei Med J. 2006; 47:759–72.

22). Heo MY, Choi SJ, Kim HS, Sohn SJ. Clinical features of atypical Kawasaki disease. Korean J Pediatr. 2002; 45:376–82.

23). Gordon JB, Kahn AM, Burns JC. When children with Kawasaki disease grow up: myocardial and vascular complications in adulthood. J Am Coll Cardiol. 2009; 54:1911–20.

24). Bal AK, Prasad D, Pamintuan MA, et al. Timing of intravenous immunoglobulin treatment and risk of coronary artery abnormalities in children with Kawasaki disease. Pediatr Neonatol. 2014; 55:387–92.

25). Newburger JW, Takahashi M, Gerber MA, 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.

26). Ohno S, Miyajima T, Higuchi M, et al. Ocular manifestations of Kawasaki's disease (mucocutaneous lymph node syndrome). Am J Ophthalmol. 1982; 93:713–7.

27). Anand S, Yang YC. Optic disc changes in Kawasaki disease. J Pediatr Ophthalmol Strabismus. 2004; 41:177–9.

28). Offret H. Disciform keratitis and Kawasaki's disease. J Fr Ophtalmol. 1993; 16:114–6.

29). Kaiura TL, Stoller GL, Florakis GJ. Inflammatory bowel disease and other systemic inflammatory diseases. Krachmer JH, Mannis MJ, Holland EJ, editors. Cornea. 3rd ed.St Louis: Mosby;2011. chap. 61.

30). Lindquist TD. Conjunctivitis: an overview and classification. Krachmer JH, Mannis MJ, Holland EJ, editors. Cornea. 3rd ed.St Louis: Mosby;2011. chap. 42.

31). Ha SJ, Lee KY, Cha SW, et al. A case of Kawasaki disease diagnosed with the assistance of ophthalmologic examination. Korean J Pediatr. 1999; 42:1014–8.