Leucocoria in a boy with Kawasaki disease: a diagnostic challenge

• Published in: Singapore medical journal Vol. 50; no. 7; pp. e232 - e234
• Main Authors: Che Mahiran, C D, Alagaratnam, J, Liza-Sharmini, A T
• Format: Journal Article
• Language: English
• Published: Singapore 01.07.2009
• Subjects: Coronary Aneurysm - complications; Coronary Aneurysm - diagnosis; Diagnosis, Differential; Eye - diagnostic imaging; Eye - physiopathology; Eye Diseases - diagnosis; Humans; Infant; Male; Mucocutaneous Lymph Node Syndrome - complications; Mucocutaneous Lymph Node Syndrome - diagnosis; Retinal Neoplasms - complications; Retinal Neoplasms - diagnosis; Retinal Neoplasms - diagnostic imaging; Retinoblastoma - complications; Retinoblastoma - diagnosis; Retinoblastoma - diagnostic imaging; Treatment Outcome; Ultrasonography
• ISSN: 0037-5675

Retinoblastoma, the most common primary intraocular malignancy of childhood, usually presents in the first three years of life. Atypical presentation of retinoblastoma can masquerade as virtually any ocular or orbital pathology, which may lead to diagnostic dilemmas especially in the presence of other systemic diseases. We report a 20-month-old boy who was diagnosed with coronary aneurysm as a complication of Kawasaki disease, and presented with sudden left eye redness. His mother noticed the presence of white pupillary reflex three months earlier. Atypical acute ocular presentation secondary to Kawasaki disease was initially suspected, but the presence of multiple calcification and mild proptosis on imaging suggested characteristics of advanced retinoblastoma. Histopathological examination of the enucleated eye, which revealed a classical rosette pattern appearance, confirmed the diagnosis. Atypical presentations of retinoblastoma are usually associated with advanced disease. The presence of other systemic conditions further complicates the diagnosis. Early diagnosis is important to reduce the mortality and morbidity.