Reactivation of Vogt-Koyanagi-Harada disease under control for more than 6 years, following anti-SARS-CoV-2 vaccination

Abstract

Background/purpose Vogt-Koyanagi-Harada (VKH) disease is a primary stromal choroiditis with bilateral granulomatous panuveitis. If initial-onset VKH is treated early and relentlessly the disease can be controlled and even “cured” in a substantial number of cases. We are reporting on a patient treated early and in a sustained fashion who was inflammation free for seven years but who presented a reactivation 6 weeks after the second dose of anti-SARS-CoV-2 vaccination. Case report A 43-year-old woman presented with severe initial-onset VKH disease which was brought under control using steroidal and non-steroidal Immunosuppression (mycophenolic acid and cyclosporine) with additional infliximab infusions because of the persistence of subclinical choroiditis identified on ICGA. Under infliximab alone disease had been inflammation free with no subclinical disease and absence of sunset glow fundus for 6 years. However, following anti-SARS-CoV-2 vaccination, severe resurgence of the disease occurred with exudative retinal detachments. Disease was rapidly brought again under control with oral prednisone (1 mg/kg) therapy and a new loading scheme of infliximab therapy. Conclusion VKH disease results from an autoimmune process directed against melanocyte associated antigens which can be controlled when early and sustained immunosuppressive treatment is introduced. It seems that anti-SARS-CoV-2 vaccination can be at the origin of reactivation of long-time controlled disease.

Ocular Adverse Events After COVID-19 Vaccination

“… A case series of numerical imbalance in incidences of Bell’s palsy between vaccine and placebo arms during trials BNT162b2, mRNA-1273 NA NA n = 7 Papasavvas et al . 33 Reactivation of Vogt-Koyanagi-Harada disease under control for more than 6 years, following anti-SARS-CoV-2 vaccination. A case report of reactivation of Vogt-Koyanagi-Harada disease post-vaccination BNT162b2 2 6 weeks Photophobia, ocular pain n = 1 Phylactou et al .…”

“…was identified. 33 The reported subject was a woman with a pre-existing diagnosis of VKH well controlled for the past six years. The initial onset of VKH was severe, necessitating infliximab infusions which were continued as regular maintenance therapy.…”

“…She had received infliximab infusions 3.5 weeks before the first vaccine dose and 7.5 weeks before the second vaccine dose. 33 Slit-lamp examination showed anterior chamber inflammation with mutton-fat keratic precipitates, and OCT was performed, revealing retinal folds, subretinal fluid and increased choroidal thickness. Oral corticosteroids were initiated, alongside infliximab therapy, with the disease reactivation brought under control.…”

Retinal Hemorrhage after SARS-CoV-2 Vaccination

“…This increases the need for ophthalmological studies on vaccine-related side-effects, where SARS-CoV-2 vaccination may become annual. Known intraocular side-effects include acute macular neuroretinopathy, central serous chorioretinopathy, reactivation of Vogt-Koyanagi-Harada disease, panuveitis, Descemet’s membrane endothelial keratoplasty (DMEK) graft rejection, retinal hemorrhage and vascular events including retinal arterial occlusion and retinal vein occlusion (RVO) [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. Here, we present a unique case series of RVO, and age-related macular degeneration (AMD) exhibiting submacular hemorrhage, temporally related to administration of SARS-CoV-2 vaccines.…”

Ocular Manifestations after Receiving COVID-19 Vaccine: A Systematic Review

“…Reactivation of Vogt-Koyanagi-Harada (VKH) Disease Papasavvas et al reported that a 40-year-old female taking infliximab for VKH disease for six years had reactivation six weeks after the second dose of BNT162b2 COVID-19 vaccine. On examination, AC inflammation, mutton-fat KPs, retinal folds, subretinal fluid, and increased choroidal thickness were noted [27].…”