Zespół Vogta–Koyanagi–Harady – opis przypadku oraz analiza współczesnych poglądów na temat procesu diagnostyczno-terapeutycznego
Vogt–Koyanagi–Harada Syndrome – Case Report and Analysis of Contemporary Views of Diagnostic and Therapeutic Process
Eunika Krzywy-Daroszewska, Magdalena Targońska, Anna Wiśniowska-Dolny, Ewa Drozdowska-Łukaszewicz
Oddział Okulistyczny Wojewódzkiego Szpitala Specjalistycznego, Ośrodek Badawczo-Rozwojowy we Wrocławiu
Ordynator: lek. med. Teresa Lange
Summary: Purpose: The aim of the study is to demonstrate a case report of 2 years follow-up, the diagnostics and therapeutic possibilities of Vogt–
Methods: Case presentation and current literature reviews including epidemiology, etiology, ocular and systemic features, disease course, clinical prognosis and management.
Results: We present our own experience in the diagnosis and treatment of a rare form of panuveitis and discuss the current literature on Vogt– –Koyanagi–Harada syndrome.
35-year-old white female attended the ophthalmic emergency room due to blurred vision in both eyes lasting for a few days and intensive headaches and eye pain for a month. Patient presented signs of vitiligo; apart from this there was no history of previous trauma or any additional diseases. We performed routine ocular examinations, US-B, optical coherence tomography of macula and optic disc in both eyes and fluoresceine angiography. The patient was diagnosed with Vogt–Koyanagi–Harada syndrome, a disease that is very rare in Caucasian patients.
Ocular examination indicated: BCVA RE – 0.1, BCVA LE – 0.2, anterior uveitis, numerous grayish iris nodules, vitreous inflammatory reaction, optic disc hyperemia with blurred margins, serous retinal detachment in posterior pole reaching vascular arches.
US B – binocular serous retinal detachment, thickened choroid;
OCT – macular thickening RE 950 mm, LE 730 mm, RNFL in both eyes 170 mm;
Blood tests results – normal;
HIV Ag/Ab and VDRL – negative;
Chest X–Ray without abnormalities.
Initial diagnosis was Vogt–Koyanagi–Harada syndrome, confirmed by FA.
Intravenous steroid therapy was initiated. At the third day of treatment visual acuity improved to BCVA RE – 0.32, BCVA LE – 0.5. Serous retinal detachment subsided almost completely.
After being discharged from the hospital patient continued oral steroid therapy. On the tenth day of the treatment patient’s visual acuity was 1.0 in both eyes, OCT images of the maculas were normal but the optic disc swelling disappeared after three months.
During 4 months of steroid treatment the ocular state was stable. Steroid induced glaucoma and systemic complications were not observed.
After 9 months of follow-up patient sustained recurrence of the disease. This was preceded by prednisolone dose reduction. She was admitted to hospital and again underwent systemic steroid therapy. Soon all pathological changes subsided and her visual acuity improved to 1.0 in both eyes. But soon afterwards she developed subcapsular cataract. Considering that additionally the patient complained of systemic adverse effects of steroids we proposed her to implement cyclosporine treatment to be able to reduce steroids. Once again she was admitted to the ward to undergo general examinations ordered by a consulting nephrologist before introducing the new drug. But after she was informed about adverse effects of cyclosporine she resigned from new cure. Therefore she remained on oral steroid treatment for the next 7 months. She had no another recurrence. She is under the care of Department of Ophthalmology of Regional Hospital of Wrocław.
Conclusion: Vogt–Koyanagi–Harada syndrome is uveitis, which is rare in Caucasian representatives. Proper diagnosis and fast treatment gives high chances of full recovery and preservation of good visual acuity. Long-term steroid therapy is linked to development of drug – induced complications, it is important to take into account alternative methods of treatment.
Słowa kluczowe: zespół Vogta–Koyanagi–Harady, VKH, uveomeningitis, uveomeningoencephalitis, wysiękowe odwarstwienie siatkówki, zapalenie błony naczyniowej, panuveitis.
Keywords: Vogt-Koyanagi-Harada syndrome, VKH, uveomeningitis, uveomeningoencephalitis, serous retinal detachment, uveitis, panuveitis.