Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
권호 표지
DOI QR코드

DOI QR Code

Usefulness of anterior uveitis as an additional tool for diagnosing incomplete Kawasaki disease

  • Lee, Kyu Jin (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Kim, Hyo Jin (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Kim, Min Jae (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Yoon, Ji Hong (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Lee, Eun Jung (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Lee, Jae Young (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Oh, Jin Hee (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Lee, Soon Ju (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Lee, Kyung Yil (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Han, Ji Whan (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
  • 투고 : 2015.09.16
  • 심사 : 2015.11.05
  • 발행 : 2016.04.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: There are no specific tests for diagnosing Kawasaki disease (KD). Additional diagnostic criteria are needed to prevent the delayed diagnosis of incomplete Kawasaki disease (IKD). This study compared the frequency of coronary artery lesions (CALs) in IKD patients with and without anterior uveitis (AU) and elucidated whether the finding of AU supported the diagnosis of IKD. Methods: This study enrolled patients diagnosed with IKD at The Catholic University of Korea, Uijeongbu St. Mary's Hospital from January 2010 to December 2014. The patients were divided into 2 groups: group 1 included patients with IKD having AU; and group 2 included patients with IKD without AU. We analyzed the demographic and clinical data (age, gender, duration of fever, and the number of diagnostic criteria), laboratory results, and echocardiographic findings. Results: Of 111 patients with IKD, 41 had uveitis (36.98%, group 1) and 70 did not (63.02%, group 2). Patients in group 1 had received a diagnosis and treatment earlier, and had fewer CALs (3 of 41, 1.7%) than those in group 2 (20 of 70, 28.5%) (P=0.008). All 3 patients with CALs in group 1 had coronary dilatation, while patients with CALs in group 2 had CALs ranging from coronary dilatation to giant aneurysm. Conclusion: The diagnosis of IKD is challenging but can be supported by the presence of features such as AU. Group 1 had a lower risk of coronary artery disease than group 2. Therefore, the presence of AU is helpful in the early diagnosis and treatment of IKD and can be used as an additional diagnostic tool.

키워드

참고문헌

  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. Ghelani SJ, Sable C, Wiedermann BL, Spurney CF. Increased incidence of incomplete Kawasaki disease at a pediatric hospital after publication of the 2004 American Heart Association guidelines. Pediatr Cardiol 2012;33:1097-103. https://doi.org/10.1007/s00246-012-0232-9
  3. 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
  4. 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
  5. Manlhiot C, Christie E, McCrindle BW, Rosenberg H, Chahal N, Yeung RS. Complete and incomplete Kawasaki disease: two sides of the same coin. Eur J Pediatr 2012;171:657-62. https://doi.org/10.1007/s00431-011-1631-2
  6. Falcini F, Cimaz R, Calabri GB, Picco P, Martini G, Marazzi MG, et al. Kawasaki's disease in northern Italy: a multicenter retrospective study of 250 patients. Clin Exp Rheumatol 2002;20:421-6.
  7. Hsieh YC, Wu MH, Wang JK, Lee PI, Lee CY, Huang LM. Clinical features of atypical Kawasaki disease. J Microbiol Immunol Infect 2002;35:57-60.
  8. Sudo D, Monobe Y, Yashiro M, Mieno MN, Uehara R, Tsuchiya K, et al. Coronary artery lesions of incomplete Kawasaki disease: a nationwide survey in Japan. Eur J Pediatr 2012;171:651-6. https://doi.org/10.1007/s00431-011-1630-3
  9. Uehara R, Igarashi H, Yashiro M, Nakamura Y, Yanagawa H. Kawasaki disease patients with redness or crust formation at the Bacille Calmette-Guérin inoculation site. Pediatr Infect Dis J 2010;29:430-3. https://doi.org/10.1097/INF.0b013e3181cacede
  10. Sinha R, Balakumar T. BCG reactivation: a useful diagnostic tool even for incomplete Kawasaki disease. Arch Dis Child 2005;90:891. https://doi.org/10.1136/adc.2004.071332
  11. Mohsenin A, Huang JJ. Ocular manifestations of systemic inflammatory diseases. Conn Med 2012;76:533-44.
  12. 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
  13. 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
  14. Lin KH, Chang SS, Yu CW, Lin SC, Liu SC, Chao HY, et al. Usefulness of natriuretic peptide for the diagnosis of Kawasaki disease: a systematic review and meta-analysis. BMJ Open 2015;5:e006703. https://doi.org/10.1136/bmjopen-2014-006703
  15. Shiraishi M, Fuse S, Mori T, Doyama A, Honjyo S, Hoshino Y, et al. N-terminal pro-brain natriuretic Peptide as a useful diagnostic marker of acute Kawasaki disease in children. Circ J 2013;77:2097-101. https://doi.org/10.1253/circj.CJ-12-1281
  16. Nakamura Y, Yashiro M, Uehara R, Watanabe M, Tajimi M, Oki I, et al. Use of laboratory data to identify risk factors of giant coronary aneurysms due to Kawasaki disease. Pediatr Int 2004;46:33-8. https://doi.org/10.1111/j.1442-200X.2004.01840.x
  17. Lega JC, Bozio A, Cimaz R, Veyrier M, Floret D, Ducreux C, et al. Extracoronary echocardiographic findings as predictors of coronary artery lesions in the initial phase of Kawasaki disease. Arch Dis Child 2013;98:97-102. https://doi.org/10.1136/archdischild-2011-301256
  18. Japan Kawasaki Disease Research Center, Japan Kawasaki Disease Research Committee. Diagnostic guidelines of Kawasaki disease [Internet]. Tokyo: Japan Kawasaki Disease Research Center, Japan Kawasaki Disease Research Committee; c2012 [cited 2015 Aug 15]. Available from: http://kawasaki-disease.org.
  19. Burke MJ, Rennebohm RM. Eye involvement in Kawasaki disease. J Pediatr Ophthalmol Strabismus 1981;18:7-11.
  20. 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
  21. Burke MJ, Rennebohm RM, Crowe W, Levinson JE. Follow-up ophthalmologic examinations in children with Kawasaki's disease. Am J Ophthalmol 1981;91:537-9. https://doi.org/10.1016/0002-9394(81)90248-8
  22. 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
  23. Madhusudan S, Singh S, Suri D, Gupta A, Gupta A. Acute anterior uveitis as the presenting feature of Kawasaki disease. Indian J Pediatr 2014;81:415. https://doi.org/10.1007/s12098-014-1367-x
  24. Cunningham ET Jr. Uveitis in children. Ocul Immunol Inflamm 2000;8:251-61. https://doi.org/10.1076/ocii.8.4.251.6459

피인용 문헌

  1. 농뇨 동반 가와사키병의 임상적 특징 vol.24, pp.3, 2017, https://doi.org/10.14776/piv.2017.24.3.141
  2. Clinical implications in laboratory parameter values in acute Kawasaki disease for early diagnosis and proper treatment vol.61, pp.5, 2016, https://doi.org/10.3345/kjp.2018.61.5.160
  3. Recent advances in the diagnosis of Kawasaki disease vol.5, pp.1, 2016, https://doi.org/10.22470/pemj.2018.00220
  4. Kawasaki disease: characteristics, diagnosis, and unusual presentations vol.15, pp.10, 2019, https://doi.org/10.1080/1744666x.2019.1659726
  5. Adjuvant herbal therapy for targeting susceptibility genes to Kawasaki disease: An overview of epidemiology, pathogenesis, diagnosis and pharmacological treatment of Kawasaki disease vol.70, pp.None, 2020, https://doi.org/10.1016/j.phymed.2020.153208
  6. Subconjunctival Acute Bilateral Hemorrhages Due to Kawasaki Disease in a Costa Rican Girl: An Unusual Clinical Manifestation of the Disease vol.12, pp.9, 2016, https://doi.org/10.7759/cureus.10212
  7. 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
  8. Bilateral anterior uveitis as a part of a multisystem inflammatory syndrome secondary to COVID‐19 infection vol.93, pp.1, 2016, https://doi.org/10.1002/jmv.26229
  9. Intravenous Immunoglobulin Treatment in Kawasaki Disease Decreases the Incidence of Myopia vol.10, pp.7, 2021, https://doi.org/10.3390/jcm10071381
  10. Bilateral Acute Anterior Uveitis and Corneal Punctate Epitheliopathy in Children Diagnosed with Multisystem Inflammatory Syndrome Secondary to COVID‐19 vol.29, pp.4, 2016, https://doi.org/10.1080/09273948.2021.1909070
  11. Epidemiology and Long-term Sequelae of Pediatric Uveitis vol.62, pp.1, 2016, https://doi.org/10.1097/iio.0000000000000393