Azathioprine During the First Trimester of Pregnancy in a Patient with Vogt-Koyanagi-Harada Disease: A Multimodal Imaging Follow-Up Study

Abstract

Patient: Female, 27Final Diagnosis: Vogt Koyanagi Harada DiseaseSymptoms: Headache • vision lossMedication: —Clinical Procedure: —Specialty: OphthalmologyObjective:Unusual clinical courseBackground:The aim of this study was to describe the case of a 27-year-old woman who developed Vogt-Koyanagi-Harada (VKH) disease in the 13th week of pregnancy, who was treated with high-dose oral corticosteroids and azathioprine due to its persistent course.Case Report:A 27-year-old East Indian woman in her 13th week of pregnancy presented with bilateral decreased visual acuity and metamorphopsia due to bilateral serous retinal detachments and was diagnosed with Vogt-Koyanagi-Harada (VKH) disease. Multimodal imaging, including blue light fundus autofluorescence (FAF), structural spectral domain optical coherence tomography (SD-OCT), en-face OCT, and OCT angiography (OCT-A), was performed at presentation and follow-up, being particularly helpful for identifying recurrences. Her treatment consisted of high-dose corticosteroid therapy, and azathioprine had to be added as an adjuvant due to the aggressive behavior of the disease. She gave birth to a healthy baby at 31 weeks of gestation and remained with 20/20 vision at 8 weeks postpartum.Conclusions:To the best of our knowledge, this is the first report on the use of azathioprine in VKH disease during pregnancy with a successful outcome. Multimodal imaging avoiding the use of fundus fluorescein angiography is key in the diagnosis and follow-up of VKH disease in pregnant women.

Bacillary Layer Detachment: Multimodal Imaging and Histologic Evidence of a Novel Optical Coherence Tomography Terminology

“…Mean ± SD baseline best-corrected visual acuity was 0.98 ± 0.92 logarithm of the minimum angle of resolution (Snellen equivalent: 20/191). Underlying etiologies included VKH disease (47%), 12,18–40,S41–S65 acute posterior multifocal placoid pigment epitheliopathy (11%), S66–S80 sympathetic ophthalmia (7.3%), S61,S81–S89 choroidal neovascularization (6.2%), 11,S90,S91 toxoplasmosis chorioretinitis (5.5%), 6,10,S92–S97 acute idiopathic maculopathy (5.5%), 7,S98–S105 immunotherapy-related toxicity (3.7%), 10,S106–S109 hematological disorders (2.4%), S110–S112 posterior scleritis (1.8%), 10,S47,S113 choroidal metastasis (1.8%), 10 central serous chorioretinopathy (1.8%), 10,S114 panretinal photocoagulation (0.6%), S115 peripapillary pachychoroid syndrome (0.6%), 9 ocular blunt trauma (0.6%), 8 uveal effusion syndrome (0.6%), S116 choroidal lymphoma (0.6%), S117 choroidal osteoma (0.6%), 10 chikungunya-associated uveitis (0.6%), S118 laser-induced maculopathy (0.6%), S119 bilateral diffuse uveal melanocytic proliferation (0.6%), S120 choroidal granuloma (0.6%), S121 and preeclampsia (0.6%). S122 Choroidal neovascularization included neovascular AMD, idiopathic choroidal neovascularization, and proliferative macular telangiectasia Type 2.…”

Idiopathic multifocal choroiditis and punctate inner choroidopathy: an evaluation in pregnancy

“…Two case reports documented a similar finding in patients treated with azathioprine for Vogt–Koyanagi–Harada disease and Crohn’s disease (Ingolotti et al. 2019 ; Lauterbach et al. 2020 ).…”

“…In our study, one patient treated with azathioprine developed the complication of ICP and spontaneously delivered preterm an infant with a low-birth weight. Two case reports documented a similar finding in patients treated with azathioprine for Vogt-Koyanagi-Harada disease and Crohn's disease (Ingolotti et al 2019;Lauterbach et al 2020). This retrospective study comes with several limitations.…”

Vogt‐Koyanagi‐Harada disease in pregnancy: Case report and review of 32 patients in the literature

“…A sufficient description was found in 32 patients with Vogt‐Koyanagi‐Harada disease in pregnancy (Table 1). 15–44 …”

“…Vogt‐Koyanagi‐Harada disease may occur in pregnancy and pose a problem how to apply the standard of care in a pregnant woman 12–14 . In this report, we described a patient who developed Vogt‐Koyanagi‐Harada disease in pregnancy and also summarized 32 patients with the disease in pregnancy in the literature to elucidate the outcome of treatment 15–44 …”