A case of probable Vogt–Koyanagi–Harada disease in a 3-year-old girl

Abstract

Background Vogt–Koyanagi–Harada (VKH) disease is a T-cell-mediated autoimmune disorder characterized by bilateral granulomatous panuveitis with various systemic manifestations. Although VKH disease rarely occurs in the pediatric population, the clinical course tends to be aggressive, and the visual prognosis is worse than that in adult patients due to severe ocular complications secondary to recurrent inflammation. Case presentation A 3-year-old girl with probable VKH was referred to Kobe University Hospital. She had severe bilateral panuveitis with posterior synechiae of the iris, marked optic disk swelling, and serous retinal detachment in both eyes, and her best corrected visual acuities (BCVAs) were 20/200 OD and 20/125 OS. A third course of therapy was administered because serous retinal detachment remained after two courses of therapy. She was treated with three courses of high-dose intravenous corticosteroid therapy, followed by slow tapering of oral corticosteroids. Her BCVAs recovered to 20/16 OU, and relapse of ocular inflammation and side effect of treatment were not observed during the 1.5-year follow-up period. Conclusions We experienced a pediatric patient with probable VKH disease who was treated with three courses of high-dose intravenous corticosteroid therapy. With the favorable clinical course in our patient, initial treatment with repeated high-dose intravenous corticosteroid therapy might be beneficial in pediatric VKH disease.

Vogt-Koyanagi-Harada Disease: The Clinical Spectrum and Management of Case Series in a Tertiary Eye Centre in Northern Part Of Malaysia

“…Atsuko et al found that initial treatment with repeated high-dose intravenous corticosteroid therapy might benefit pediatric VKH disease [14]. Chee SP et al also found that higher doses of systemic corticosteroids may be required to ensure adequate immunosuppression in VKH patients [16].…”

Sympathetic ophthalmia in an 85-year-old female and a 90-year-old male after a non-complicated cataract surgery: a case report

“…11,12 After searching the PubMed and CiNii Research databases for cases of VKH disease (keyword, 'VKH'; search years, 2000-2022), to the best of our knowledge, the oldest reported cases of VKH disease were aged 83 years, 14,15 while the youngest reported cases were aged 3 years. [16][17][18] Because elderly individuals tend to have systemic diseases, consideration should be paid to side-effects associated with highdose systemic steroids. There are two reports about the side effects of steroid pulse therapy in elderly patients with VKH.…”

“…11,12 After searching the PubMed and CiNii Research databases for cases of VKH disease (keyword, ‘VKH’; search years, 2000–2022), to the best of our knowledge, the oldest reported cases of VKH disease were aged 83 years, 14,15 while the youngest reported cases were aged 3 years. 16–18…”

Multimodal imaging in pediatric uveitis

“…Multimodal imaging of pediatric VKH has been described in the literature in patients as young as 3 years of age, and demonstrates the utility of serial imaging for following the often aggressive disease course in children. Katsuyama et al 104 reported imaging findings of a 3-year-old girl with VKH using OCT, which demonstrated bilateral serous retinal detachments and choroidal thickening on presentation, persistence of subretinal fluid (SRF) despite two courses of high-dose intravenous corticosteroid therapy, and ultimate resolution of SRF and restoration of the ellipsoid zone after her third course of corticosteroid therapy. Khalifa et al 103 described a 12-year-old female patient who experienced improvement in serous detachments following treatment with infliximab and methotrexate treatment, but was found to have persistent submacular fluid on OCT and eventually required cyclophosphamide to achieve quiescence of inflammation.…”