Kawasaki Disease with Optic Disc Swelling and Uveitis

Kawasaki disease (KD) is the multisystem vasculitis which is a cause of secondary heart disease in children [1]. Coronary artery aneurysm could be a cause of death in some cases of KD, so it is important to diagnose coronary artery complication [2]. KD could be diagnosed by having the following criteria: prolonged fever longer than 5 days and four of the five following main clinical features: (1) changes in the peripheral extremities, (2) polymorphous rash, (3) oropharyngeal changes, (4) acute nonpurulent conjunctivitis, and (5) cervical lymphadenopathy accompanied with lymph node greater than 1.5 cm [1,3]. Bulbar conjunctival injection and anterior uveitis are dominant ocular manifestation in KD [4]. Posterior segment involvement is rare. Despite early efficient treatment including aspirin and intravenous immunoglobulins (IVIG), the bilateral inflammatory ocular involvement including punctuated keratitis, retrodescemetic precipitates, anterior uveitis, vitritis, and bilateral optic disc swelling with papillitis are observed in KD patients [5-9]. Uveitis is the common ophthalmic finding in KD. Manifestation of uveitis is mild. It is bilateral and is sometimes associated with keratic precipitates. In general, it occurs a week after fever onset and recovers within 2–8 weeks after disease onset without any sequelae. According to increasing incomplete KD, uveitis has become a more important factor in early diagnosis of incomplete KD [5]. Inflammation of both anterior and posterior segments does not seem to respond to KD-specific treatment and could justify a specific ophthalmologic therapeutic approach [4]. Grouteau et al. [4] reported severe bilateral global inflammatory involvement of the eyes in KD. It is usually subclinical and self-limited. Eye involvement in KD can lead to severe visual impairment. Kadyan et al. [10] published a case of disciform keratitis and optic disc swelling in KD. Ohno et al. [11] reported bilateral bulbar conjunctivitis, bilateral iridocyclitis, superficial punctate keratitis, vitreous opacities, papilledema and subconjunctival hemorrhage. There has not been a report of optic disc swelling associated with uveitis in the KD patient in Korea. Case Report Ewha Med J 2016;39(4):133-136 https://doi.org/10.12771/emj.2016.39.4.133 pISSN 2234-3180 • eISSN 2234-2591