A Case of Kawasaki Disease Diagnosed with the Assistance of Ophthalmologic Examination

ABSTRACT

Kawasaki disease is a systemic vasculitis in which bilateral nonexudative conjunctivitis and anterior uveitis are common early findings in the course of illness. We report an eleven-year-old boy with atypical Kawasaki disease who was diagnosed with the help of an ophthalmologic examination. The patient presented with fever, epigastric pain with vomiting, erythematous rash, and severe bilateral conjunctival injection, a red throat without strawberry tongue and scarletiniform rash on the chest and back. Cervical lymphadenopathy and changes in the extremities were not shown. Slit lamp biomicroscopic examination three days after admission revealed bilateral bulbar conjuctival injection, superficial punctate erosions, and aquous humor inflammatory reaction(3+/4+ cells and 2+/4+ flare), a manifestation of anterior uveitis. After receiving two consecutive doses of intravenous immunoglobulin(IVIG, total 2.4g/kg) the boy showed no response. He was subsequently treated with high dose methylprednisolone(14mg/kg) intravenously. Two-dimensional echocardiography 2 weeks after admission showed aneurysmal changes on the proximal parts of the left main coronary artery(4.5mm) and right coronary artery(4.0mm). Slit lamp examination early in the course of the illness can help in the diagnosis of Kawasaki disease.