Vogt-Koyanagi-Harada Associated with Diabetes Mellitus and Celiac Disease in a 3-Year-Old Girl

Purpose

To present a case of Vogt-Koyanagi-Harada (VKH) associated with type I diabetes mellitus and celiac disease in a 3 year old female.

Methods

We studied a three-year old female who presented with clinical manifestation of VKH and type I Diabetes mellitus and ciliac disease.

Results

Patient was found to have hyperglycemia with type I diabetes mellitus. Duodenal mucosal biopsy specimen confirmed the diagnosis of celiac disease. Patient's ocular inflammation was treated by topical and systemic corticosteroid and immune-suppressive therapy. Her diabetes mellitus was controlled by insulin and her celiac disease was controlled by gluten-free diet.

Conclusions

The association of VKH with two autoimmune diseases (celiac disease and type I diabetes mellitus) is rare. This case is, to our knowledge, the youngest patient reported with VKH.

Intraocular Inflammation in Diabetic Populations

PURPOSE OF REVIEW

The purpose of this review is to determine the prevalence of uveitis in the diabetic population, the clinical features of the uveitis and diabetes when coexisting and pathophysiology of a possible correlation. We also aim to review the cases of diabetes and uveitis in the literature.

RECENT FINDINGS

The basis of an association between uveitis and diabetes mellitus (DM) is the common pathophysiology of inflammation. There are several reports on a DM-related uveitis, defined as idiopathic anterior uveitis in the presence of poorly controlled DM, but causation has not been established. There are conflicting results in the literature regarding an association between uveitis and DM. More studies are needed to determine if an association truly exists.

Vogt-Koyanagi-Harada disease, diabetes mellitus, and psoriasis in a child

PURPOSE

To report a case of a child with near-simultaneous onset of Vogt Koyanagi Harada disease (VKH) and insulin-dependent diabetes mellitus (IDDM).

DESIGN

Interventional case report.

METHODS

An 11-year-old child with known psoriasis presented with headache and bilateral granulomatous panuveitis. Nine weeks later, he presented with diabetic ketoacidosis and IDDM. Diffuse choroidal depigmentation followed within months. HLA was positive for DRB1*0405. Despite aggressive local and systemic therapy, the ocular disease was complicated by bilateral cataracts, angle closure glaucoma, and choroidal neovascularization.

RESULTS

The patient is currently pseudophakic in one eye and aphakic in the other, with best-corrected visual acuity of 6/24 and 6/5, respectively.

CONCLUSIONS

VKH may present in children with panuveitis in the setting of other autoimmune disorders. Treating such patients is complicated by the need to minimize systemic corticosteroid use. A combination of local therapy and systemic steroid-sparing agents should be the mainstay of treatment.

Type 1 diabetes mellitus associated with Graves' disease and Vogt-Koyanagi-Harada syndrome

A 30-year-old woman was diagnosed as having Vogt-Koyanagi-Harada (VKH) syndrome. Her past history was Graves' disease. She was administered 1 g of methylprednisolone for three days, which was followed by oral prednisolone. Four weeks later, she developed hyperglycemic hyperosmolar coma. She was treated with intravenous normal saline and insulin, and glycemic control was improved. She was diagnosed as having type 1 diabetes mellitus (DM) because of positive test results for glutamic acid decarboxylase (GAD) antibodies and islet cell antibodies. Her human leukocyte antigen (HLA) genotypes were DQB1(*)0401 and DRB1(*)0405, which were susceptible genes for VKH syndrome, type 1 DM and Graves' disease. Therefore, we should consider that VKH syndrome might be associated with type 1 DM or Graves' disease.

High-grade lymphoma after azathioprine treatment for Vogt-Kaganayi-Harada syndrome

Vogt-Kaganayi-Harada (VKH) syndrome is a rare autoimmune disease characterized by panuveitis, neuropathy and aseptic meningitis. Most patients require long-term treatment with steroids and immunosuppressants. Patients may develop concurrent autoimmune diseases, especially endocrinopathies. Secondary malignancies are rare associations. We report a Chinese man with VKH syndrome presenting with multiple cranial nerve palsy and bilateral pan-uveitis, who developed disseminated high-grade B cell lymphoma after 3-year treatment with azathioprine. This is the first report of systemic non-Hodgkin lymphoma in patients with VKH syndrome. The carcinogenic properties of azathioprine on an abnormally expanded but non-clonal lymphoid system may play a role in the pathogenesis.