Sensorineural hearing loss associated to Kawasaki Disease

Abstract

ResumoObjetivo: a doença de Kawasaki (DK) é uma vasculite sistêmica idiopática, autolimitada, de pequenos e médios vasos. Foram descritos na literatura treze casos de deficiência auditiva neurossensorial, durante a evolução dessa doença. Descreve-se o caso de um lactente com doença de Kawasaki com evolução, durante a fase aguda, para deficiência auditiva neurossensorial. A descrição do caso justifica-se por ilustrar uma complicação grave da DK, pouco mencionada na literatura, que reforça a recomendação de cautela na avaliação global destes pacientes.Descrição: menino hígido de 1 ano e sete meses de idade apresentou-se com febre diária persistente, iniciada havia sete dias, associada à irritabilidade, conjuntivite bilateral não-exsudativa, eritema máculo-papular em tronco. Evoluiu com artrite em punhos, cotovelos, joelhos e tornozelos e edema e descamação de mãos e pés, que impossibilitava a deambulação. O diagnóstico de doença de Kawasaki foi estabelecido de acordo com os critérios da American Heart Association (AHA), e a criança foi tratada de forma convencional. Houve regressão das manifestações clínicas três dias após o início do tratamento. Contudo, um mês após o início dos sintomas, os familiares notaram resposta insatisfatória a estímulos sonoros. A avaliação da acuidade auditiva através do BERA (Brainstem Evoked Responses Audiometry -Audiometria de Potenciais Evocados de Tronco Cerebral) diagnosticou perda auditiva neurossensorial bilateral, grau severo a profundo.Comentários: é possível que o exame rotineiro de acuidade auditiva em crianças com doença de Kawasaki possa identificar precocemente a deficiência auditiva neurossensorial. J Pediatr (Rio J) 2002; 78 (1): 71-74: vasculite, síndrome do linfonodo mucocutâneo, perda auditiva sensorioneural. AbstractObjectives: Kawasaki disease is a systemic idiopathic selflimited vasculitis of small and medium-sized vessels. Thirteen cases of sensorineural hearing loss during the evolution of this disease have been described in the literature. We describe a case of an infant with Kawasaki disease who developed sensorineural hearing loss during the acute phase. This case report shows a complication of Kawasaki disease, with few citations in literature, enhancing the importance of careful evaluation of these patients.Description: nineteen-month-old-boy, formerly healthy, with persistent daily fever seven days before admission, associated with irritability, bilateral nonexudative conjunctivitis and maculopapular erythema on his trunk. There was later development of arthritis on wrists, elbows, knees, and ankles, and swelling associated with desquamation of hands and feet, which prevented him from walking. The diagnosis of Kawasaki disease was established according to the American Heart Association's criteria, and the child was conventionally treated. There was regression of clinical manifestations three days after the beginning of treatment. However, one month after the onset of symptoms, the family noticed an unsatisfactory response to sound stimuli. The evaluation of...

Kawasaki disease and sensorineural hearing loss: an (un)expected complication

“…Involvement of CNS may occur in approximately 30% of patients with KD and is usually transient [3,10].…”

“…This complication seems to occur mainly during the first days of the disease (febrile stage), prior to the implementation of specific treatment (usually between the fifth and tenth day after the onset of disease, when the diagnosis of KD can be established based on clinical criteria) [4,10].…”

“…Sensorineural hearing loss in KD is usually described as transient and bilateral, and reports of persistent or severe unilateral hypoacusia are scarce [3,10]. Although uncommonly reported as a complication of KD, its actual prevalence is probably underestimated, as hearing acuity decline in most cases of KD tends to be discrete and transient, and, especially at younger ages, difficult to be perceived by parents [4,10].…”

“…Although uncommonly reported as a complication of KD, its actual prevalence is probably underestimated, as hearing acuity decline in most cases of KD tends to be discrete and transient, and, especially at younger ages, difficult to be perceived by parents [4,10].…”

“…It is currently the most common cause of acquired coronary heart disease affecting the pediatric age group (approximately 25% of untreated patients) [7,9]. The spectrum of clinical manifestations may also include the involvement of the central nervous system (CNS), albeit less frequently [4,10].…”