Abstract
Background
Vasculitis in children constitute a heterogeneous group of pathologies considered as a rarity in our context and therefore deserves to be better known. Despite their individualization for more than forty years throughout the world, they continue to be a challenging condition both in terms of diagnosis and treatment. The objective of our study is to report the epidemiological profiles of vasculitis and to assess the clinical and Para clinical profile of our patients, in order to contribute to a better knowledge of these conditions in our context, whose early diagnosis allows the starting of an appropriate treatment and the improvement of the prognosis.
Material and methods
This is a retrospective study, in which we collected data of all children in whom the diagnosis of vasculitis was confirmed, and who were hospitalized in the pediatric department of the University Hospital Center (CHU) Mohamed VI of Oujda over a period of 3 years from July 2014 to July 2017.
Results
Thirty-three patients were selected; 25 boys (76%) and 8 girls (24%), including 16 patients with Kawasaki disease; 14 patients with Henoch-Schonlein purpura (HSP); 2 patients with Polyarteritis nodosa (PAN); and 1 patient with Takayasu. A male predominance was noted with a sex ratio of 3.16. HSP represented 42.42% of the cases, the most affected age group was between 5 and 9 years in 45% of cases. Purpura was the most frequent symptom (100%) with petechial appearance in 77% of cases and localized in the lower limbs in all cases (100%). Joints were affected in 13 cases (93%), abdominal symptoms were found in 81.82% of cases, with one case of melena and 3 cases of rectal bleeding. The renal symptoms were mainly biological and were dominated by urinary proteinuria (45%), microscopic hematuria in one case, macroscopic hematuria in 3 cases, hypertension in one case and nephrotic syndrome in one case. Five patients developed renal insufficiency, two children had moderate renal insufficiency and three had severe renal insufficiency. Kawasaki disease represented the majority of cases: 16 cases (48.48%), affecting children between 4 and 41 months of age with an average age of 22 months, with most affected age group was between 12 and 24 months in 55%. The appeal signs were multiple dominated by fever which represents 100% of cases, skin rash in 82%, ocular redness in 45%, enanthema in 45%, oedema of the extremities in 45%, and adenopathy in 6% (one case). The inflammatory syndrome was present in all patients. Cardiac Doppler ultrasound was performed in 14 patients. It was abnormal in 22% of cases. 11 patients received a course of IGIV (54.54%), at a dose of 2 g/Kg in a single 12-h infusion. Aspirin was administered in all patients. The evolution was favorable in 15 patients, only one case was complicated by giant aneurysms of both coronaries, which evolved to a slight decrease in size and disappearance of the pericardial effusion. Valvular abnormality was noted in one case and minimal pericardial effusion in one case.
Conclusion
This study confirmed that incidence of vasculitis in children in our context is average, this can be seen on the non-negligible number of cases (33 cases) collected over a period of 3 years. Early diagnosis of this condition key to allow an initiation of an appropriate treatment and improvement of the prognosis.
Uveitis as an important ocular sign to help early diagnosis in Kawasaki disease
