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

Choi, Han Seul; Lee, Seul Bee; Kwon, Jung Hyun; Kim, Hae Soon; Sohn, Sejung; Hong, Young Mi

doi:10.3345/kjp.2015.58.10.374

Cited by 30 publications

(36 citation statements)

References 22 publications

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“…Coronary artery lesions (CAL) are one of the most important complications of this disease. Ocular involvement in this disease is characterized by non-exudative conjunctivitis and anterior uveitis [2]. Posterior segment involvement is rare; however, recent studies have shown the involvement of the ocular posterior segment in the acute phase of Kawasaki disease [3,[5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Blindness and ocular posterior segment involvement in the acute phase of Kawasaki disease: a mini-review

Nakad¹

2016

IOSRPHR

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: Ocular involvement in the acute phase of Kawasaki disease typically involves the anterior segment of the eye, and its associated treatment outcomes are generally excellent. However, there are rare reports of posterior segment involvement, and these are associated with poorer outcomes. This study reviewed six patients with recently reported blindness and/or ocular posterior segment involvement in the acute phase of Kawasaki disease. The median age of these patients was 8.5 years old (range: 6-12 years old). The ocular symptoms were photophobia, reduction of vision, blindness, and ocular pain. Five patients exhibited optic disc involvement and three patients showed retinal vessel involvement. All patients received intravenous immunoglobulin therapy and two patients received systemic corticosteroid administration. The visual acuity outcomes of treatment were excellent in five of the patients. However, in one patient there was still no light perception in the affected eye at two months after the initial onset of the disease. This was associated with the possible obstruction of the ophthalmic artery due to vasculitis. Older children may have a higher associated risk of blindness and ocular posterior segment involvement in the acute phase of Kawasaki disease.

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Section: Introductionmentioning

confidence: 99%

Blindness and ocular posterior segment involvement in the acute phase of Kawasaki disease: a mini-review

Nakad¹

2016

IOSRPHR

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“…11,16 Tedaviye başlamadan önce dikkate alınması gereken en önemli şey gecikmiş tedavinin koroner arter komplikasyonu ile ilgili olmasıdır. Bu nedenle erken tanı ve tedavi, koroner arter komplikasyonlarını azaltmak için daha önemli hâle gelmektedir.…”

Section: Resi̇m 3unclassified

“…Buradaki en önemli etken, inkomplet KH'deki tanı ve tedavinin gecikmesi olarak gösterilmekte-dir. 11,16,17 Tanı için öncelikle, beş günden uzun süren ateşli hastalarda ve/veya ateş odağı bulunduğu hâlde uygun tedaviye dirençli olan hastalarda bu hastalık-tan şüphe etmek ve kardiyak etkilenme açısından ekokardiyografik inceleme yapmak gerekmektedir.…”

Section: Resi̇m 3unclassified

“…11,20 Ayrıca iridosiklit, yüzeyel noktasal keratit, vitreus opasiteler ve papil ödem diğer göz bulguları arasında yer almaktadır. 21 Ön üveit inkomplet KH'de tanı için önemli bir uyarıcı olarak değerlendirilebilir.…”

Section: Resi̇m 3unclassified

“…Üveit önemli ölçüde hastanın yaşı ve nötrofil sayısı ile ilişkilidir. 11 Genellikle, gözde kıza-rıklık ve fotofobi şikâyetleri olmaktadır.…”

Section: Resi̇m 3unclassified

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Kawasaki Disease Presented with Unusual Findings: Report of Two Cases

Yakut¹,

Ecevit²,

Varan³

et al. 2017

Turkiye Klinikleri J Pediatr

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Turkiye Klinikleri J Pediatr 2017;26(3):94-8 94 awasaki hastalığı (KH), Henoch-Schönlein purpurasından sonra ço-cukluk çağının en sık görülen sistemik vaskülitidir.1-3 Epidemiyolojik ve klinik bulgular etiyolojik olarak enfeksiyöz bir nedeni kuvvetle desteklese de hastalığın etiyolojisi tam olarak bilinmemektedir. Ateş ortaya çıktıktan birkaç gün sonra hastalığın diğer klinik bulguları gö-rülmektedir. Oral mukoza değişiklikleri, bilateral pürülan olmayan konSıra Dışı Bulgularla Seyreden Kawasaki Hastalığı: İki Olgu Ö ÖZ ZE ET T Kawasaki hastalığı (KH) nedeni bilinmeyen ve genellikle beş yaşın altındaki çocuklarda gö-rülen sistemik bir vaskülittir. Çocukluk çağında Henoch-Schönlein purpurasından sonra en sık gö-rülen ikinci vaskülit nedenidir. Hastalığın en önemli komplikasyonu koroner arter anevrizmasıdır. Bu nedenle erken tanı ve tedavi prognoz açısından çok önemlidir. Kawasaki hastalığında kesin tanı koydurucu laboratuvar bulgularının olmaması ve klinik bulguların çok değişken olması erken tanı ve tedaviyi zorlaştırmaktadır. İnkomplet seyirli vakaların varlığı nedeni ile beş günden uzun süren ateşli hastalarda KH ayırıcı tanıda düşünülmelidir. Bu hastalarda kardiyak komplikasyonlar açısın-dan tekrarlayan ekokardiyografik incelemeler yapılmalıdır. Bu çalışmada sunulan ilk olgu olan beş yaşındaki erkek çocuğu, parafaringeal flegmon nedeni ile tedavi almakta iken ateşin devam etmesi üzerine şüphelenilip kardiyak değerlendirme sonrası KH tanısı aldı. İkinci olgumuz olan 11 yaşın-daki erkek çocuğunun 10 gündür ateş, ellerde soyulma ve fotofobi şikayetleri vardı. Ekokardiyografik incelemede koroner arter dilatasyonu olan olguda KH tanısı düşünülerek tedavi başlandı. Bu çalışmada, atipik prezantasyon gösteren veya tedaviye dirençli ateşi olan hastaların ayırıcı tanısında KH'nın düşünülmesi gerektiğinin vurgulanması amaçlanmıştır.A An na ah ht ta ar r K Ke el li im me el le er r: : Mukokutanöz lenf nodu sendromu; ekokardiyografi; üveit; koroner anevrizma A AB BS ST TR RA AC CT T Kawasaki disease (KD) is an idiopathic vasculitis syndrome which is largely seen in children under five years of age. It is the most common vasculitis encountered in childhood secondary to Henoch-Schönlein. Although it has a good prognosis with treatment, can lead to death from coronary artery aneurysm. Thus early diagnosis and treatment play a crucial role in prognosis of disease. Varying clinical signs and absence of definitive diagnostic laboratory findings pose a challenge for early diagnosis and treatment. Cases with fever lasting more than five days should alarm the physician as incomplete cases may be encountered. Serial echocardiographic examination must be performed in such cases regarding the cardiac complications. Our first patient is a five years-old male who has been treated for parapharyngeal phlegmon. He was consulted to our unit as his fever has been lasting for five days despite treatment and finally diagnosed as KD. Second patient is an eleven years-old male who was diagnosed as KD due to his fever lasting for ten days, pe...

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Acute Bilateral Eyelid Edema in a 3-Year-Old Girl With Pyuria

2018

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A 3-year-old Asian girl presented to the emergency department with high fever (>40°C) of 2 days' duration, bilateral upper and lower eyelid edema, and dysuria. Results of urinalysis revealed pyuria, and she was prescribed oral cephalexin, 250 mg every 12 hours, for a presumed urinary tract infection. The patient returned 2 days later with persistent fever, worsening eyelid edema, and a new macular rash over her buttocks and shins. At this time, the ophthalmology service was consulted owing to concern for Stevens-Johnson syndrome precipitated by the treatment with cephalexin.On examination, her visual acuity was central, steady, and maintained in each eye. Motility and pupil reactions were normal. There was moderate edema of the upper and lower eyelids bilaterally with erythema and several areas of shallow ulceration that were weeping a yellowish serous discharge (Figure , A). This type of edema was associated with moderate hyperemia of the palpebral conjunctiva (Figure , B). Results of the ocular surface examination revealed minimal bulbar conjunctival injection, the cornea was clear, and there was no discharge. Cephalexin was discontinued, the patient was admitted, and a diagnostic workup was initiated, including swabs from the eyelid lesions and conjunctiva for bacterial cultures and viral polymerase chain reaction testing. Results of blood laboratory testing revealed an elevated erythrocyte sedimentation rate and an elevated level of C-reactive protein, as well as elevated liver enzymes. Moderate edema of upper and lower eyelidsA Moderate hyperemia of palpebral conjunctiva B Figure. On initial evaluation, the patient displayed bilateral eyelid edema and erythema with multiple areas of shallow ulceration (A) and moderate palpebral conjunctival hyperemia (B). WHAT WOULD YOU DO NEXT? A. Start corticosteroid eyedrops and check daily for pseudomembrane formation B. Perform echocardiography and administer intravenous immunoglobulin C. Perform Tzanck smear on swab from ulcerated lesion D. Institute contact precautions and prescribe mupirocin ointment to eyelid skin Clinical Review & Education

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

Cited by 30 publications

References 22 publications

Blindness and ocular posterior segment involvement in the acute phase of Kawasaki disease: a mini-review

Blindness and ocular posterior segment involvement in the acute phase of Kawasaki disease: a mini-review

Kawasaki Disease Presented with Unusual Findings: Report of Two Cases

Acute Bilateral Eyelid Edema in a 3-Year-Old Girl With Pyuria

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