Confusion of a poststreptococcal syndrome complicated by uveitis with mucocutaneous lymph node syndrome

This article describes the case of a 13-year-old black male who fulfilled the diagnostic criteria for mucocutaneous lymph node syndrome (MLNS), but developed severe posterior uveitis. Because severe posterior uveitis is not reported in MLNS, the patient's diagnostic evaluation was repeated and a markedly elevated antistreptolysin O titer detected. Since severe posterior uveitis is known to complicate streptococcal infection, we concluded this was the more likely etiology of the child's illness. This was an important differentiation, because prednisone therapy was felt to be indicated for the uveitis but is contraindicated in MLNS. This case also highlights the importance of careful and sometimes repeated diagnostic evaluation before the description of a previously unreported manifestation of a disease for which no single diagnostic test exists. If the diagnostic workup had not been repeated, this child would have been reported as having severe posterior uveitis complicating MLNS.