Vogt–Koyanagi–Harada syndrome: a rheumatologic perspective

Vogt-Koyanagi-Harada Syndrome (VKHS): First Two Cases Reported in Pediatric Age Group in Oman

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.

Ocular syphilis mimicking Vogt-Koyanagi-Harada disease

The study aimed to present a case of ocular syphilis mimicking Vogt-Koyanagi-Harada (VKH) disease. This is an observational case report. A 59-year-old female with Sicca syndrome and rheumatoid arthritis presented to the ophthalmologic department with blurred vision of the right eye for 5 days accompanied by color sensation loss in both eyes. Bilateral disc hyperemia and serous retinal detachment at the posterior pole were noted in her both eyes by fundus examination. Fluorescein angiography revealed bilateral late dye leakage from the disc and posterior choroid. Optical coherence tomography showed bilateral subretinal fluid and choroidal thickening. The impression of her condition was VKH disease initially. However, she was later diagnosed with bilateral ocular syphilis with optic neuritis which was proved by laboratory data. After appropriate antimicrobial agent treatment, her best-corrected visual acuity, serous retinal detachment, and disc hyperemia improved. There was no recurrent intraocular inflammation even without systemic steroid or immunosuppressive therapy control during the following 1 year. Ocular syphilis can mimic many other ocular inflammatory diseases including VKH disease. It is necessary to differentiate infectious causes from inflammatory origins due to the substantially different treatment and prognosis.

Treatment-refractory autoimmune sensorineural hearing loss: response to infliximab

We conducted a retrospective study to assess the effects of infliximab, a chimeric monoclonal antibody, on hearing in patients with autoimmune sensorineural hearing loss who had previously not responded to steroid therapy and/or treatment with other immunosuppressive drugs such as methotrexate and cyclophosphamide. We reviewed the records of 8 such patients. Our objective measures of outcome were pure-tone averages at 500, 1,000, 2,000, and 3,000 Hz and speech discrimination scores. At the completion of treatment, no patient exhibited a positive response to infliximab therapy by objective measurements, and only 1 patient (12.5%) reported subjective improvement.

Vogt-Koyanagi-Harada disease: diagnosis and treatments update

PURPOSE OF REVIEW

To review current advances in the diagnosis and therapy of Vogt-Koyanagi-Harada (VKH) disease.

RECENT FINDINGS

A new T-cell subset (Th17) may play an important role in the initiation and maintenance of inflammatory disease when stimulated by the interleukin (IL)-23, thus producing IL-17. Recent developments of new imaging techniques, such as high-resolution optical coherence tomography 3 scanner (OCT3), have allowed greater accuracy in VKH disease diagnosis. The OCT3 examinations have shown that cystoid spaces appear in the neurosensory layer (between the inner and outer segments of photoreceptors) and not in the subretinal space. This structural finding was also supported by functional studies with multifocal electroretinography that measured the photoreceptors activity. Antimetabolites (azathioprine, mycophenolate mofetil and methotrexate), T-cell inhibitors (cyclosporine and tacrolimus) and biologic agents, associated with the well known glucocorticosteroids therapy, showed good results in acute and chronic phases of the disease. Intravitreal triamcinolone and bevacizumab were reported to have encouraging results for progressive or stubborn cases of VKH disease.

SUMMARY

To uphold visual acuity, an early, fast and accurate diagnosis is necessary, followed by an aggressive and lengthy immunosuppressive treatment.