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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.
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Table 1.
Diagnostic criteria for Kawasaki disease5
Table 2.
Characteristics of all patients who suspected of Kawasaki disease referred from department of pediatrics
| KD (n = 46) | Non-KD (n = 14) | Total (n = 60) | p-value | |
|---|---|---|---|---|
| Age (months) | 40.39 ± 22.10 | 44.67 ± 35.59 | 40.96 ± 24.38 | p = 0.35 |
| Male | 22 (47.83%) | 10 (71.43%) | 32 (53.33%) | p = 0.04* |
| The number of satisfied diagnostic criteria of the KD | 4.93 ± 1.09 | 4.22 ± 0.83 | 4.81 ± 1.08 | p = 0.03* |
| Fever duration before ophthalmologic exam (days) | 5.14 ± 1.15 | 5.11 ± 2.03 | 5.13 ± 1.52 | p = 0.48 |
| Total fever duration (days) | 7.63 ± 1.56 | 6.78 ± 1.06 | 7.48 ± 1.64 | p = 0.08 |
| Conjunctival injection | 46 (100%) | 12 (85.71%) | 58 (96.67%) | p = 0.08 |
| Uveitis | 32 (69.57%) | 0 (0%) | 32 (53.33%) | p < 0.001* |
| Conjunctival follicles | 1 (2.17%) | 3 (21.43%) | 4 (6.67%) | p = 0.005* |
| Eye wax | 8 (17.39%) | 2 (14.29%) | 10 (16.67%) | p = 1.00 |
| Eye itching | 1 (2.17%) | 1 (7.14%) | 2 (3.33%) | p = 0.42 |
| Conjunctival chemosis | 1 (2.17%) | 0 (0%) | 1 (1.67%) | p = 1.00 |
Values are presented as mean ± SD unless otherwise indicated. Student's t-test between the KD and non-KD group in age, sex, the number of satisfied diagnostic criteria of KD, and total fever duration. Fisher's exact test between the KD and non-KD group in uveitis, eye wax, eye itching, and conjunctival chemosis. KD = Kawasaki disease.
Table 3.
Final diagnosis of non-Kawasaki disease patients
Table 4.
Characteristics of typical and atypical Kawasaki disease patients
| Total KD (n = 46) | Typical KD (n = 32) | Atypical KD (n = 14) | p-value | |
|---|---|---|---|---|
| Age (months) | 40.39 ± 22.10 | 44.00 ± 21.56 | 39.16 ± 25.78 | p = 0.27 |
| Age of patients with uveitis | 45.55 ± 21.64 | 45.13 ± 20.38 | 47.00 ± 9.21 | p = 0.04*,† |
| Age of patients without uveitis | 26.11 ± 18.07 | 18.29 ± 9.21 | 38.76 ± 23.73 | |
| Male (n, %) | 22 (47.83) | 16 (50.00) | 6 (42.86) | p = 0.13 |
| Sex of patients with uveitis (n/N, %) | 13/32 (40.63) | 12/25 (48.00) | 1/7 (14.29) | p = 0.13† |
| Sex of patients without uveitis (n/N, %) | 9/14 (64.29) | 4/7 (57.14) | 5/7 (71.43) | |
| The number of satisfied diagnostic criteria for KD | 4.93 ± 1.09 | 5.16 ± 1.17 | 4.27 ± 1.27 | p = 0.008* |
| Fever duration before ophthalmologic examination (days) | 5.14 ± 1.15 | 4.94 ± 1.27 | 5.73 ± 1.41 | p = 0.06 |
| Total fever duration (days) | 7.63 ± 1.56 | 7.47 ± 1.15 | 8.09 ± 1.19 | p = 0.13 |
| Conjunctival injection (%) | 46 (100) | 32 (100) | 14 (100) | p = 1.00 |
| Uveitis (n, %) | 32 (69.57) | 25 (78.13) | 7 (50.00) | p = 0.08 |
| Eye wax (n, %) | 8 (17.39) | 7 (21.88) | 1 (7.14) | p = 0.40 |
| Eye itching (n, %) | 1 (2.17) | 1 (3.13) | 0 (0) | p = 1.00 |
| Conjunctival chemosis (n, %) | 1 (2.17) | 1 (3.13) | 0 (0) | p = 1.00 |
| Duration of uveitis after clinical diagnosis (n/N, %) | p = 0.50 | |||
| <7 days | 4/32 (12.50) | 4/25 (16.00) | 0/7 (0) | |
| 7-14 days | 23/32 (71.88) | 17/25 (68.00) | 6/7 (85.71) | |
| ≥14 days | 5/32 (15.63) | 4/25 (16.00) | 1/7 (14.29) | |
| Patients with IVIG treatment (%) | 43 (93.48) | 32 (100) | 11 (78.57) | |
| Patients with CAL (%) | 4 (8.70) | 1 (3.13) | 3 (21.43) | p = 0.08 |
| Patients with both uveitis and CAL (%) | 3/4 (75.00) | 1/1 (100) | 2/3 (66.67) | p = 1.00 |
Values are presented as mean ± SD unless otherwise indicated. Student's t-testing of the differences between the typical and atypical KD group in age, sex, the number of satisfied diagnostic criteria of KD, and fever duration. Mann-Whitney testing of the differences between the total patients with uveitis and the total patients without uveitis group in age and sex. Fisher's exact testing of the differences between the typical and atypical KD group in conjunctival injection, uveitis, eye wax, eye itching, conjunctival chemosis, and incidence of CAL. Chi-square testing of the differences between the typical and atypical KD group in duration of uveitis. KD = Kawasaki disease; IVIG = intravenous immunoglobulin; CAL = coronary artery lesion.
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