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Al Hashmi S, Al Habsi N, Al Abrawi S. Vogt-Koyanagi-Harada Syndrome (VKHS): First Two Cases Reported in Pediatric Age Group in Oman. Case Rep Pediatr 2023; 2023:1745603. [PMID: 37928616 PMCID: PMC10622593 DOI: 10.1155/2023/1745603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 09/24/2023] [Accepted: 09/28/2023] [Indexed: 11/07/2023] Open
Abstract
The Vogt-Koyanagi-Harada syndrome (VKHS) is a unique form of granulomatous autoimmune disease that mostly impacts the pigmented tissues of the body. The main feature is bilateral granulomatous panuveitis, which is detected on ophthalmologic examination, along with additional systemic signs such as vitiligo, white hair, neurological involvement, or hearing loss. This study aims to report two cases of Vogt-Koyanagi-Harada syndrome presented in the children age group, which is unusual and very rare, to improve recognition of this disease to avoid complications and delay referral.
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Affiliation(s)
- Samiya Al Hashmi
- Department of Child Health, Pediatric Rheumatology Unit, Royal Hospital, Muscat, Oman
| | - Nasra Al Habsi
- Department of Ophthalmology, Ophthalmology Unit, Al Nahdah Hospital, Muscat, Oman
| | - Safiya Al Abrawi
- Department of Child Health, Pediatric Rheumatology Unit, Royal Hospital, Muscat, Oman
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Kaya P, İnanç Tekin M, Özdal PÇ. Predictive Factors for the Prognosis of Vogt-Koyanagi-Harada Disease. Ocul Immunol Inflamm 2023; 31:1687-1693. [PMID: 36628436 DOI: 10.1080/09273948.2022.2159841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 12/13/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE To identify the prognostic factors in Vogt-Koyanagi-Harada (VKH) disease. METHODS This study included 23 patients (46 eyes) with acute-phase VKHdivided into two subgroups: Group 1; acute-resolved (10 patients), group 2; chronic-recurrent (13 patients). RESULTS Mean age were 29.5 ± 10.2 years in group 1, 35.8 ± 12.2 years group 2 (p = .033). Best-corrected visual acuity with logMAR at admission was 0.91 ± 0.65 in group 1, 0.88 ± 0.62 in group 2 (p = .798), and improved to 0.08 ± 0.24, 0.18 ± 0.6, respectively (p = .557). Extraocular findings were detected in 30% in group 1, and 53.8% in group 2 at the time of admission (p = .108). All patients were treated with 1 g/day 3-5 days intravenous steroid, and 10 patients had immunomodulatory treatment. Initiation of immunomodulatory therapy did not affect the prognosis (p = .676). CONCLUSION Older patients and/or who developed extraocular findings at the presentation were more prone to show recurrences.
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Affiliation(s)
- Pınar Kaya
- Department of Opthalmology, University of Health Science, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
| | - Merve İnanç Tekin
- Department of Opthalmology, University of Health Science, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
| | - Pınar Çakar Özdal
- Department of Opthalmology, University of Health Science, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
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Muacevic A, Adler JR, Barri A, Al Dhibi H. Bilateral Complete Loss and Partial Regeneration of Photoreceptor Layers in a Pediatric Vogt-Koyanagi-Harada (VKH) Case. Cureus 2022; 14:e32273. [PMID: 36628028 PMCID: PMC9823270 DOI: 10.7759/cureus.32273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Vogt-Koyanagi-Harada (VKH) disease is a multisystem autoimmune disease affecting melanocyte-containing tissues in the eyes, meninges, ear, and skin. As far as we are aware, this is a unique case report documenting the regeneration of the photoreceptor layer after bilateral complete loss of the photoreceptor layer in a child with VKH. We report a case of a 12-year-old male with no significant past medical history who presented during the chronic stage of incomplete VKH. He was found to have a complete loss of photoreceptor layer in both eyes during a work-up to confirm the aforementioned disease. Upon receiving his first pulse dose of 500 mg IV methylprednisolone as a treatment course, he developed severe steroid-induced hyperglycemia (random blood glucose of 17.6 mmol/L). Additionally, a brain MRI revealed pituitary gland changes compatible with diabetes insipidus, which is a combination that was mentioned once in the literature before. A review of the systems did not suggest any other systemic diseases. The patient's elevated blood sugar level was managed by a pediatrician, and it normalized. At his last visit, optical coherence tomography (OCT) showed hypertrophy/regeneration of the photoreceptor layer. This case report indicates that retinal photoreceptor layer regeneration can be sometimes observed with follow-up after the resolution of inflammation and uveitis.
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Kaza H, Tyagi M, Agarwal K, Behera S, Pappuru RR, Mohan S, Saldanha M, Videkar C, Basu S, Pathengay A, Murthy S. Vogt Koyanagi Harada Disease In Paediatric Age Group: Clinical Characteristics, Remission, Recurrences and Complications in Asian Indian Population. Semin Ophthalmol 2021; 37:187-192. [PMID: 34224303 DOI: 10.1080/08820538.2021.1948067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To describe disease characteristics and outcomes of Vogt-Koyanagi-Harada (VKH) syndrome in paediatric patients. STUDY DESIGN Retrospective chart analysis. METHODS: A RETROSPECTIVE Analysis of all patients ≤16 years with VKH syndrome was done. Clinical presentations, complications, recurrences and outcomes in cases of paediatric VKH were reviewed. RESULTS 72 eyes of 36 patients with a mean age at presentation of 13.7 ± 2.34 years were assessed. Mean duration of symptoms and follow up were 9.88 ± 17.3 weeks and 55 months respectively. Clinical signs at presentation included anterior chamber cells >2+(34/72eyes, 47.2%), granulomatous keratic precipitates (6 eyes, 8.3%), posterior synechiae (35 eyes,48.6%), disc edema (46 eyes, 63.8%), neurosensory retinal detachments (44 eyes, 61.1%) and 'sunset-glow' fundus (9 eyes, 12.5%). Best corrected visual acuity (BCVA) at the time of presentation was 1.3logMAR or a Snellens equivalent of 20/400 which improved to 0.51logMAR (Snellens equivalent of 20/63) at last follow up. Remission was achieved in 61.1% cases. More than half of our patients developed one or more complications. CONCLUSION VKH in paediatric patients poses a challenge due to a delayed presentation and paediatric VKH patients have a worse visual acuity at the time of presentation as compared to adult age groups. Rates of remission may be low along with high risk of complications and hence there is a need for prolonged immunosuppression.
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Affiliation(s)
- Hrishikesh Kaza
- Uveitis and Ocular Immunology Services, LV Prasad Eye Institute, Hyderabad, India
| | - Mudit Tyagi
- Uveitis and Ocular Immunology Services, LV Prasad Eye Institute, Hyderabad, India.,Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L.V. Prasad Eye Institute, Hyderabad, India
| | - Komal Agarwal
- Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L.V. Prasad Eye Institute, Hyderabad, India
| | - Shashwat Behera
- Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L.V. Prasad Eye Institute, Hyderabad, India
| | - Rajeev R Pappuru
- Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L.V. Prasad Eye Institute, Hyderabad, India
| | - Sashwanthi Mohan
- Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L.V. Prasad Eye Institute, Hyderabad, India
| | - Merlin Saldanha
- Uveitis and Retina Services, GMRV Campus, L.V. Prasad Eye Institute, Visakhapatnam, India
| | - Chetan Videkar
- Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L.V. Prasad Eye Institute, Hyderabad, India
| | - Soumyava Basu
- Uveitis and Ocular Immunology Services, LV Prasad Eye Institute, Hyderabad, India
| | - Avinash Pathengay
- Uveitis and Retina Services, GMRV Campus, L.V. Prasad Eye Institute, Visakhapatnam, India
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Albalawi AM, Al-Barry MA. Genetic variations in autoimmune genes and VKH disease. Int Ophthalmol 2020; 40:3175-3186. [PMID: 32974831 DOI: 10.1007/s10792-020-01407-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 04/28/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Vogt-Koyanagi-Harada (VKH) disease is a rare autoimmune disease. The autoimmune response in VKH disease is against the melanin-producing cells; therefore, in affected individuals melanocyte-containing organs manifest disease symptoms including eyes, ears, skin and nervous system. VKH is a multifactorial disease, and the precise cause of the VKH disease is unknown. Studies have suggested that both environmental and genetic factors are responsible for the VKH disease. In this review, the authors have collected all the available literature on the genetics of VKH to their knowledge and discussed the role of genetic variants in causing VKH disease. METHODS An extensive literature search was performed in order to review all the published studies regarding VKH clinical phenotyping and genetic variants in VKH disease. Medline, PubMed, Cochrane library, and Scopus was searched using combination of keywords. RESULTS It was found that variants in HLA genes, IL-12b, TNFSF4, and miR-20-5p genes are significantly associated with VKH; however, variants in genes ATG10, TNIP1 and CLEC16A did not achieve significant genome-wide association threshold. Moreover, polymorphisms in TNIP1 and CLEC16A play a protective role against VKH. CONCLUSION The authors conclude that increased sample size and a more homogeneous VKH patient population may reveal a significant association of variants in ATG10, TNIP1 and CLEC16A genes with VKH disease.
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Affiliation(s)
- Alia M Albalawi
- Department of Biology, College of Science, King AbdulAziz University Jeddah, Jeddah, Saudi Arabia.,Center for Genetics and Inherited Diseases, Taibah University Almadinah Almunawwarah, Medina, Saudi Arabia
| | - Maan A Al-Barry
- Department of Ophthalmology, College of Medicine, Taibah University Almadinah Almunawwarah, Medina, Saudi Arabia.
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Albaroudi N, Tijani M, Boutimzine N, Cherkaoui O. Clinical and therapeutic features of pediatric Vogt-Koyanagi-Harada disease. J Fr Ophtalmol 2020; 43:427-432. [PMID: 32115269 DOI: 10.1016/j.jfo.2019.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/03/2019] [Accepted: 10/09/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE To analyze clinical, therapeutic and prognostic features of pediatric Vogt-Koyanagi-Harada (VKH) disease. MATERIAL AND METHODS This retrospective study included 16 eyes of 8 children diagnosed with VKH disease followed at a teaching hospital over a 10 year period. Diagnosis was based on the revised criteria of VKH disease. All data were analyzed using SPSS® software. RESULTS There were 62.5% girls and 37.5% boys. The mean age (years) was 14.6±4.4. The mean follow-up (months) was 38.7±28.7. The mean initial visual acuity (VA) (LogMAR) was 1.4 with 68.8% of eyes presenting with severe visual loss at admission. The median time (days) required for resorption of the serous retinal detachment was 10 [8.25-25]. Extraocular signs were present in 62.5% of cases. The mean time until initiation of treatment was 25.6 days. 62.5% of patients received corticosteroids alone, and 37.5% of patients received a combination of corticosteroids and immunosuppressive therapy. Final VA was 0.4 [0.1-2.3]. In our study, the time until consultation, low initial VA and recurrences were statistically associated with severe visual loss (P≤0.05). CONCLUSION Life expectancy in pediatric cases of VKH disease justifies the early initiation of immunosuppressive treatment or even biological therapy to achieve better steroid sparing and preserve visual function.
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Affiliation(s)
- N Albaroudi
- Service d'ophtalmologie A, hôpital des spécialités, centre hospitalier universitaire, université Mohammed V, Rabat, Morocco.
| | - M Tijani
- Service d'ophtalmologie A, hôpital des spécialités, centre hospitalier universitaire, université Mohammed V, Rabat, Morocco
| | - N Boutimzine
- Service d'ophtalmologie A, hôpital des spécialités, centre hospitalier universitaire, université Mohammed V, Rabat, Morocco
| | - O Cherkaoui
- Service d'ophtalmologie A, hôpital des spécialités, centre hospitalier universitaire, université Mohammed V, Rabat, Morocco
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Marquezan MC, Nascimento H, Dalbem D, Muccioli C, Belfort R. Vogt-Koyanagi-Harada Syndrome in Brazilian Children. Ocul Immunol Inflamm 2019; 28:402-408. [DOI: 10.1080/09273948.2019.1588982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Maria Carolina Marquezan
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, UNIFESP, Sao Paulo, Brazil
| | - Heloisa Nascimento
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, UNIFESP, Sao Paulo, Brazil
| | - Daniele Dalbem
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, UNIFESP, Sao Paulo, Brazil
| | - Cristina Muccioli
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, UNIFESP, Sao Paulo, Brazil
| | - Rubens Belfort
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, UNIFESP, Sao Paulo, Brazil
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Su E, Oza VS, Latkany P. A case of recalcitrant pediatric Vogt-Koyanagi-Harada disease successfully controlled with adalimumab. J Formos Med Assoc 2019; 118:945-950. [PMID: 30616991 DOI: 10.1016/j.jfma.2018.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/24/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022] Open
Abstract
Vogt-Koyanagi-Harada (VKH) disease is uncommon in the pediatric population and can have an aggressive course with serious visual sequelae. A 12-year-old Han Chinese American female, who presented with mild headaches and panuveitis with diffuse serous retinal detachments, was diagnosed with VKH. Despite treatment with a combination of high-dose systemic corticosteroids, intravitreal triamcinolone injection, and mycophenolate mofetil, ocular inflammation was inadequately controlled. Addition of adalimumab allowed for inflammation remission, improvement of vision, and tapering of systemic corticosteroids. Escalation of immunosuppression until remission appears to be critical in this population. Further research is needed to understand the complex pathophysiology of VKH and investigation for similar efficacy of other anti-tumor necrosis factor-alpha agents will need to be performed.
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Affiliation(s)
- Emily Su
- Department of Ophthalmology, The New York Eye and Ear Infirmary of Mount Sinai, New York, USA; Department of Ophthalmology, Chung Shan Medical University Hospital, Taichung City, Taiwan; School of Medicine, Chung Shan Medical University, Taichung City, Taiwan.
| | - Vikash S Oza
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, USA
| | - Paul Latkany
- Department of Ophthalmology, The New York Eye and Ear Infirmary of Mount Sinai, New York, USA; Midtown Ophthalmology, P.C. Manhattan, New York, USA
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A challenged case of Vogt-Koyanagi-Harada syndrome: when dermatological manifestations came first. Int Ophthalmol 2017; 38:793-798. [PMID: 28361380 DOI: 10.1007/s10792-017-0504-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Vogt-Koyanagi-Harada syndrome (VKHS) is an inflammatory systemic autoimmune disease principally affecting pigmented tissues in the ocular, auditory, integumentary and central nervous systems. Patients are generally women in the fourth decade of life. The prognosis is correlated mainly with the time between diagnosis and the start of treatment and number of recurrent episodes of inflammation. Most complications are mainly ocular. The purpose of this paper is to describe a clinical case of VKHS. MATERIAL AND METHODS A child with a challenging clinical presentation in which the dermatological symptoms occurred before ocular manifestations. DISCUSSION AND CONCLUSION VKHS is rare in children and can be a diagnostic challenge. It seemed interesting to share this case as an opportunity to expand our knowledge of the clinical spectrum of diseases and reflect about current diagnostic criteria.
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Juvenile Vogt-Koyanagi-Harada Disease in Which Good Visual Prognosis Was Derived from Swift and Definitive Diagnosis. Case Rep Ophthalmol Med 2016; 2016:7936729. [PMID: 27110416 PMCID: PMC4826703 DOI: 10.1155/2016/7936729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/15/2016] [Indexed: 11/20/2022] Open
Abstract
We report an 8-year-old girl who manifested Vogt-Koyanagi-Harada (VKH) disease. At the first visit, conjunctival hyperemia, inflammation in the anterior chamber, serous retinal detachment, and papillitis were observed in both eyes. Fluorescein angiography (FA) revealed bilateral subretinal fluid and papillitis. Ocular computed tomography (OCT) showed subretinal fluid and choroidal hypertrophy underneath macula in both eyes. Cerebrospinal fluid examination indicated aseptic meningitis. Systemic data did not suggest the other systemic diseases. Therefore, she was diagnosed with incomplete VKH disease. After corticosteroid pulse therapy, oral prednisolone was administered for seven months. Eighteen days after the induction of the treatments, inflammation in the anterior chamber and serous retinal detachment of both eyes disappeared completely. For seven months after the induction of the treatments, she had no relapses of any symptoms. Cerebrospinal fluid examination and FA for children are difficult to conduct, since it is difficult to get informed consent of these examinations from their parents. However, those thorough examinations enable us to make a swift and definitive diagnosis of VKH disease, thus assuring good visual prognosis. We have to bear in mind that juvenile VKH disease is very rare, yet when it occurs, ophthalmologic examinations help us diagnose and treat it.
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Takada S, Tanaka R, Kurita N, Ishii K, Kaburaki T. Vogt-Koyanagi-Harada disease in 3-year-old boy. Clin Exp Ophthalmol 2015; 43:593-4. [DOI: 10.1111/ceo.12512] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 01/18/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Sachiko Takada
- Department of Ophthalmology; Nadogaya Hospital; Kashiwa-City Chiba Japan
- Department of Ophthalmology; University of Tokyo Graduate School of Medicine; Tokyo Japan
| | - Rie Tanaka
- Department of Ophthalmology; University of Tokyo Graduate School of Medicine; Tokyo Japan
| | - Naoyuki Kurita
- Department of Ophthalmology; Saitama Red Cross Hospital; Saitama-City Saitama Japan
| | - Kiyoshi Ishii
- Department of Ophthalmology; Saitama Red Cross Hospital; Saitama-City Saitama Japan
| | - Toshikatsu Kaburaki
- Department of Ophthalmology; University of Tokyo Graduate School of Medicine; Tokyo Japan
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Greco A, Fusconi M, Gallo A, Turchetta R, Marinelli C, Macri GF, De Virgilio A, de Vincentiis M. Vogt-Koyanagi-Harada syndrome. Autoimmun Rev 2013; 12:1033-8. [PMID: 23567866 DOI: 10.1016/j.autrev.2013.01.004] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objectives of this study are to review our current knowledge of the aetiopathogenesis of Vogt-Koyanagi-Harada syndrome, including viral infection, genetic factors and immunomediated mechanisms, and to discuss pathogenesis and its relevance to pharmacotherapy. SYSTEMATIC REVIEW METHODOLOGY Relevant publications from 1965 to 2012 on the aetiopathogenesis and pharmacotherapy of VKHS were analysed. RESULTS AND CONCLUSION Vogt-Koyanagi-Harada syndrome (VKHS) is a rare multisystemic autoimmune disease that affects tissues containing melanin, including the eye, inner ear, meninges, and skin. The disease is characterised by bilateral uveitis associated with a varying constellation of auditory, neurological and cutaneous manifestations. The disease occurs more frequently among people with darker skin pigmentation. Asians, Native Americans, and Hispanics are most frequently affected. It predominates in patients aged between 20 and 50years, and females are affected more frequently, with a female:male ratio of 2:1. The classic clinical course is characterised by bilateral panuveitis, hypoacusis, and meningitis, in addition to cutaneous involvement with poliosis, vitiligo, and alopecia. Although the exact cause of VKH disease remains unknown, it is thought to be a T-cell-mediated autoimmune process directed against melanocytes. VKHS classically begins with vague systemic symptoms suggestive of a viral infection, although a clear association between a specific viral agent and the disease has not been established. Genetic factors may play an important role in the loss of self-tolerance in VKHS. The HLA-DRB1*0405 allele is the main susceptibility allele for VKHS. Early and aggressive systemic corticosteroids are still the primary initial therapy for VKHS. Ocular complications may require an intravitreous injection of corticosteroids. Despite proper treatment with steroids, a number of patients experience recurrent attacks or steroid-associated complications. Thus, non steroid immunomodulatory therapy (IMT) has become necessary for the treatment of VKHS.
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Affiliation(s)
- A Greco
- Department Organs of Sense, ENT Section, University of Rome La Sapienza, Italy
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Abstract
A 6-year-old Hispanic boy presented to the ophthalmology department with complaints of pain, photophobia, and blurry vision of both eyes. He was found to have bilateral granulomatous panuveitis, cataracts, and high intraocular pressures. He later developed multiple asymptomatic, ovoid, hypopigmented patches over the mid-lumbosacral back. Biopsy of lesional skin was significant for low melanocyte counts and a mild lymphocytic infiltrate. The patient was diagnosed with Vogt-Koyanagi-Harada syndrome (VKH). This article reviews the literature regarding the cutaneous presentation of VKH.
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Affiliation(s)
- Claudia Hernandez
- Department of Dermatology, University of Illinois, Chicago, Illinois 60612, USA.
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Prevalence, clinical characteristics, and causes of vision loss in children with Vogt-Koyanagi-Harada disease in South India. Retina 2010; 30:1113-21. [PMID: 20168275 DOI: 10.1097/iae.0b013e3181c96a87] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to describe the prevalence, clinical characteristics, and causes of vision loss in children with Vogt-Koyanagi-Harada disease seen at a uveitis referral center in South India. METHODS Charts of patients with Vogt-Koyanagi-Harada disease examined in the uveitis referral clinic of Aravind Eye Hospital between January 1998 and December 2007 were reviewed. A subset of patients <or=16 years of age was identified, and the clinical characteristics and causes of vision loss were evaluated. RESULTS Vogt-Koyanagi-Harada disease was diagnosed in 267 of 22,959 patients (1.2%) during the study period. Twenty-two children (8.2%) were identified, including 13 girls (59.1%) and 9 boys (40.9%). Age at presentation ranged from 8 years to 16 years, with a mean and a median of 12.6 and 13.5 years, respectively. The most common complaints were blurred vision (39 eyes, 88.6%) and eye redness (36 eyes, 81.8%). Fifteen (68.5%) children had headaches, 6 (27.3%) developed meningismus and alopecia, 4 (18.2%) developed poliosis and vitiligo, and 3 (13.6%) had tinnitus or dysacusis. Initially, all were treated with oral prednisone, but 12 (54.6%) required methotrexate, 5 (22.7%) required azathioprine, and 2 (9.1%) required cyclophosphamide. Seventy-five percent of eyes had a final visual acuity of >or=20/40, whereas 13.6% had a final visual acuity of <or=20/200. CONCLUSION Vogt-Koyanagi-Harada disease is an uncommon cause of uveitis in children. The clinical characteristics of pediatric Vogt-Koyanagi-Harada disease in South India resembled those described in cohorts from other regions. Although children in our cohort tended to do well with prompt diagnosis and treatment, long-term vision loss can occur.
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Khalifa YM, Bailony MR, Acharya NR. Treatment of Pediatric Vogt-Koyanagi-Harada Syndrome with Infliximab. Ocul Immunol Inflamm 2010; 18:218-22. [DOI: 10.3109/09273941003739910] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Pediatric non-infectious uveitis remains a rare but potentially sight-threatening group of diseases. However, early screening and treatment can improve outcomes. No single agent has proven to be efficacious in all cases. A wide variety of long-term immunomodulatory treatments are available; these agents differ in both their potency and side effect profiles. Corticosteroids remain an extremely valuable form of treatment in the short-term management of uveitis. Other major groups of immunomodulatory treatments include the calcineurin inhibitors and antimetabolites such as methotrexate, which is frequently used as the first-line agent. The biologics, including anti-tumor necrosis factor agents and interferons, are newer and potentially very useful therapies although side effects limit their use. Successful outcomes may be achieved with appropriate immunosuppressant therapy given early in the disease, although clinical trials are required to define the true efficacy of this strategy.
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Abstract
PURPOSE Vogt-Koyanagi-Harada syndrome is a bilateral, chronic, diffuse granulomatous panuveitis frequently associated with neurological, auditory, and integumentary manifestations. It is also one of the most common forms of uveitis among pigmented races including Chinese patients. METHODS This article reviews the current developments of Vogt-Koyanagi-Harada syndrome, including epidemiology, etiology, clinical features, observational techniques, genetics, treatment, and prognosis. RESULTS Increasing reports have been published to describe the clinical features of Vogt-Koyanagi-Harada syndrome in various ethnic populations from different parts of the world. In spite of tremendous progress in laboratory and clinical research, the etiology of Vogt-Koyanagi-Harada syndrome is still not completely known. Numerous studies indicate an autoimmune nature for this disease. A recent study has shown that Th17, a new subset of T cell, plays an important role in the initiation and maintenance of this disease. Early and aggressive systemic corticosteroids are still the mainstay of initial therapy for Vogt-Koyanagi-Harada syndrome. However, nonsteroid immunomodulatory therapy, including cyclosporine, chlorambucil, cyclophosphamide, and azathioprine have brought out encouraging results. Improved visual outcomes in patients with Vogt-Koyanagi-Harada syndrome in recent years have been reported when compared with decades ago, presumably due to the more aggressive use of immunosuppressive agents. CONCLUSION Although the prognosis for VKH syndrome was greatly improved, future prospective, controlled, multi-center studies are needed to determine the optimal treatment regime for this disease. The IL17/23 pathway may provide a novel therapeutic target to control inflammation in VKH syndrome.
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Affiliation(s)
- Wang Fang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, P. R. China.
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Advances in the diagnosis and immunotherapy for ocular inflammatory disease. Semin Immunopathol 2008; 30:145-64. [PMID: 18320151 DOI: 10.1007/s00281-008-0109-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Accepted: 02/04/2008] [Indexed: 02/07/2023]
Abstract
Significant advances in the diagnosis and therapy for uveitis have been made to improve the quality of care for patients with ocular inflammatory diseases. While traditional ophthalmic examination techniques, fluorescein angiography, and optical coherence tomography continue to play a major role in the evaluation of patients with uveitis, the advent of spectral domain optical coherence tomography and fundus autofluorescence into clinical practice provides additional information about disease processes. Polymerase chain reaction and cytokine diagnostics have also continued to play a greater role in the evaluation of patients with inflammatory diseases. The biologic agents, a group of medications that targets cytokines and other soluble mediators of inflammation, have demonstrated promise in targeted immunotherapy for specific uveitic entities. Their ophthalmic indications have continued to expand, improving the therapeutic armentarium of uveitis specialists.
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