Vogt–Koyanagi–Harada syndrome in the setting of COVID‐19 infection

Abstract

Vogt-Koyanagi-Harada (VKH) disease is a T-cellmediated multisystemic autoimmune inflammatory disorder characterized by skin, ocular, auditory, and neurologic involvement. The T-cell-mediated granulomatous intraocular inflammation is responsible for vitritis, disk edema, serous retinal detachments, and eventual sunset glow fundus. 1 T cells target melanocytes, with an ensuing cascade leading to four distinct disease phases as follows: prodromal, uveitis, convalescent, and recurrent. 2 VKH symptoms include headache, meningismus, hearing loss, poliosis, alopecia, and vitiligo. 3 It is most prevalent in Asians, Native Americans, Hispanics, and Middle Easterners. If promptly and adequately treated, patients can experience good outcomes and avoid complications including sunset glow fundus, cataracts, glaucoma, subretinal fibrosis, and choroidal neovascularization. Some studies have reported the link between some viral infections such as cytomegalovirus (CMV) and Epstein-Barr virus (EBV) and the development of VKH. It has been postulated that similarity between peptides on melanocytes and some exogenous viral peptides lead to adverse T cells attacks on melanocytes-containing tissues and lead to the symptoms seen in VKH. 4 We report a case of a VKH syndrome in a patient diagnosed with COVID-19. | CASE REPORTA 27-year-old male patient with no significant past medical history presented with a two-week history of intermittent unilateral headache, bilateral eye pain with photophobia, and phonophobia, followed by tinnitus and blurry vision, which ultimately progressed to total bilateral vision loss. His initial physical examination was unremarkable including vitals, except for total bilateral visual loss with preserved light perception. An ophthalmologic examination revealed normal intraocular pressure and panuveitis with serous retinal detachments bilaterally.The patient was admitted for further evaluation. Infectious work-up revealed positive COVID-19 PCR. Other infectious and metabolic panels were unremarkable. Cerebrospinal fluid studies (CSF), venereal disease research laboratory test (VDRL), fluorescent treponemal antibody absorption test (FTA), QuantiFERON gold, flow cytometry, cytology, and cultures were all negative, except for moderate pleocytosis with lymphocytic predominance

Vogt–Koyanagi–Harada disease after SARS‐CoV‐2 infection: Case report and literature review

“…24 Eatz and Charles reported a case of VKH disease 2 weeks after COVID-19 infection onset and suggested that SARS-CoV-2 may be an immunological trigger of VKH if the onset of COVID-19 infection preceded the onset of VKH symptoms by 2 weeks or occurred during the prodromal VKH phase. 23 Table 1 presents the clinical characteristics of our case in comparison to previously reported cases of VKH disease in temporal association with COVID-19 infection. Among the 5 cases, there was 1 male and 4 females, with ages ranging from 23 to 37 years.…”

“…To the best of our knowledge, there have been some cases of VKH disease after COVID‐19 vaccination reported 20–22 . However, the number of reported cases associating VKH disease with SARS‐CoV‐2 is limited to only five 23–28 . For the first time, Santamaria et al described the possible associations between SARS‐CoV‐2 infection and VKH disease 24 .…”

“… 20 , 21 , 22 However, the number of reported cases associating VKH disease with SARS‐CoV‐2 is limited to only five. 23 , 24 , 25 , 26 , 27 , 28 For the first time, Santamaria et al described the possible associations between SARS‐CoV‐2 infection and VKH disease. 24 Eatz and Charles reported a case of VKH disease 2 weeks after COVID‐19 infection onset and suggested that SARS‐CoV‐2 may be an immunological trigger of VKH if the onset of COVID‐19 infection preceded the onset of VKH symptoms by 2 weeks or occurred during the prodromal VKH phase.…”

“… 24 Eatz and Charles reported a case of VKH disease 2 weeks after COVID‐19 infection onset and suggested that SARS‐CoV‐2 may be an immunological trigger of VKH if the onset of COVID‐19 infection preceded the onset of VKH symptoms by 2 weeks or occurred during the prodromal VKH phase. 23 …”

Vogt–Koyanagi–Harada Disease after SARS-CoV-2 Infection: Case Report

“…For the first time, Santamaria et al described the possible associations between SARS-CoV-2 infection and VKH disease 20 . Eatz reported a case of VKH disease 2 weeks after COVID-19 infection onset, and suggested that SARS-CoV-2 may be a immunological trigger of VKH if COVID-19 infection onset was prior to the 2-week history of VKH symptom onset, or during the prodromal VKH phase 21 . With all these facts, the triggering role of COVID-19 infection in the development of VKH disease is widely accepted but still uncertain.…”