Conjunctival changes in children with Kawasaki disease: cytopathologic characterization.

OBJECTIVE: To examine the cytopathological changes in the conjunctiva of patients with active Kawasaki disease.

STUDY DESIGN: Case-control prospective study. Bilateral conjunctival swabs were obtained from 3 groups of children: patients with acute KD (11), age-matched controls (7), and patients with inactive KD (9). The ThinPrep prepared and Papanicolaou stained smears were examined blindly by 2 cytopathologists. The cell count differential of cells was performed and recorded quantitatively and comparisons between the 3 patient groups were made.

RESULTS: Only neutrophil counts showed a significant difference among the 3 groups. The average scores for the acute KD, control group, and patients with inactive KD were 3.5, 1.6 and 1.3, respectively. Using the Pearson chi2 test, the difference between the acute KD and the inactive group was statistically significant for both eyes (right p = 0.049, left p = 0.004). Samples from acute KD patients were more cellular. Neutrophils surrounding conjunctival epithelial cells, or "neutrophilic rosetting", were seen in 4 (36%) cases of the active disease group but not in the other groups.

CONCLUSION: "Neutrophilic conjunctivitis" is characteristic in patients of acute KD that may be of value in the initial evaluation and subsequent follow-up of KD patients.