Vogt–Koyanagi–Harada disease following BCG vaccination and tuberculosis

Abstract

Introduction To describe the characteristics, diagnosis, and treatment of the first documented case of Vogt–Koyanagi–Harada (VKH) disease following BCG vaccination (Patient 1) and the first documented case of both VKH disease and tuberculosis (Patient 2).Two patients were diagnosed with VKH disease and monitored using fundus photography, fundus autofluorescence, fluorescein angiography (FA), spectral-domain optical coherence tomography, and enhanced depth imaging optical coherence tomography (EDI-OCT).Case description A 39-year-old patient (Patient 1) had bilateral granulomatous anterior uveitis and serous retinal detachment. FA showed multiple punctuate hyperfluorescent lesions and multilobular pools of dye. EDI-OCT revealed serous retinal detachment, subretinal septa, and cystoid spaces. A 40-year-old woman (Patient 2) presented with a 3-week history of decreased vision, headache and tinnitus. Fundus examination showed bilateral disc swelling with serous retinal detachment and retinal folds. She had been diagnosed with tuberculosis. EDI-OCT showed fluctuation of the internal limiting membrane (ILM), retinal folds, retinal pigment epithelial (RPE)-Bruch membrane undulation, choroidal folds, serous retinal detachment. Both of the patients received high dosage of steroid treatment during the diagnosis. A fast recovery in VKH symptoms was observed following the treatment.Discussion and evaluationImmunological mechanisms and dysregulation of the immune system may play a significant role in the association between VKH disease and BCG.ConclusionsEDI-OCT imaging demonstrated structural changes in the photoreceptor layer, RPE-Bruch membrane, choroid, outer retina, ILM in acute VKH.

Acute-onset Vogt-Koyanagi-Harada like uveitis following Covid-19 inactivated virus vaccination

“…Like our case, VKH-like uveitis is reported to occur mostly in association with the inactivated vaccinates against yellow fever, influenza, BCG and HPV. 10 , 11 , 12 , 13 However, there are reported VKH diseases related to Pfizer mRNA as well as the adenovirus vector vaccine (AZD1222). Reactivation of VKH disease after the second dose of of Pfizer mRNA (BNT162b2) has also been reported.…”

“…VKH-like uveitis is a very rare adverse event of vaccination, and only several cases have been reported worldwide following vaccines against yellow fever, influenza, hepatitis B, and human papilloma virus (HPV), as well as following administration of the bacille Calmette-Guerin (BCG) vaccine. 10 , 11 , 12 , 13 Recently, cases of VKH disease following Covid-19 mRNA and adenovirus vector vaccine have been reported. 14 We report a case of bilateral VKH-like disease following an inactivated Covid-19 virus vaccine.…”

Vogt-Koyanagi-Harada Syndrome following COVID-19 and ChAdOx1 nCoV-19 (AZD1222) vaccine

“…Dogan et al described a case of VKH following BCG vaccination in a patient treating superficial transitional cell carcinoma (TCC) of the bladder, and another one with both VKH and tuberculosis. The authors speculated that M. tuberculosis and BCG proteins induce high Th1 responses causing uveitis by antigenic mimicry [ 13 ].…”

Bacille Calmette-Guérin: An ophthalmic perspective

“…While polymerase chain reaction and interferon-gamma release assays (IGRA) are available, health care systems in low to moderate income countries continue to rely on the PPD-based Mantoux test. Unlike IGRA, the Mantoux test can potentially re-boost delayed hypersensitivity or alter the immunologic milieu 18 .The subsequent impact on ocular inflammation has not been overtly studied, except for isolated case reports 18 , 33 . Further, BCG vaccination too can lead to a positive Mantoux test.…”

“…Dogan described two cases of Vogt-Koyanagi-Harada (VKH) disease following four cycles of IBCG 33 . One of these had a previous history of tuberculosis and had received antitubercular drugs for nine months.…”