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Concurrent acute Vogt-Koyanagi-Harada disease in one eye and chronic disease in the fellow eye.

Khochtali S, Abroug N, Hani MS, Khairallah-Ksiaa I, Jelliti B, Khairallah M - J Ophthalmic Inflamm Infect (2015)

Bottom Line: The patient received systemic corticosteroids and mycophenolate mofetil.The patient may present only when the fellow eye is affected.A significant delay before involvement of the second eye leads to atypical features of acute disease in one eye and chronic disease in the other eye.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia, khochtali.sana@gmail.com.

ABSTRACT

Background: Vogt-Koyanagi-Harada (VKH) disease is a granulomatous panuveitis, usually involving both eyes at the same time or within a few days or weeks. Acute and chronic diseases are characterized by distinct clinical features, treatment modalities, and visual outcomes. We report an atypical case of probable VKH disease, with features of acute disease in one eye and chronic disease in the fellow eye.

Findings: A 53-year-old female presented with exudative retinal detachment associated with mild vitritis in the right eye and anterior uveitis, vitritis, and sunset-glow fundus in the left eye. Based on clinical findings and results of multimodal imaging including fundus photography, spectral-domain optical coherence tomography, fluorescein angiography, indocyanine green angiography, and B-scan ultrasonography, a diagnosis of acute VKH disease in the right eye and chronic VKH disease in the left eye was made. The patient received systemic corticosteroids and mycophenolate mofetil. After a 15-month follow-up, the right fundus eye was normal, and there was a sunset-glow fundus in the left eye.

Conclusions: VKH disease may begin with asymptomatic unilateral ocular involvement. The patient may present only when the fellow eye is affected. A significant delay before involvement of the second eye leads to atypical features of acute disease in one eye and chronic disease in the other eye.

No MeSH data available.


Related in: MedlinePlus

Right color fundus photography at the last follow-up. Fundus photograph of the right eye, 15 months after presentation, shows normal findings
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Fig3: Right color fundus photography at the last follow-up. Fundus photograph of the right eye, 15 months after presentation, shows normal findings

Mentions: The patient was given oral prednisone initiated with a dose of 1 mg/kg/day and then gradually tapered over 6 months. In addition to that, she received mycophenolate mofetil (2 mg a day) for a 12-month duration. After a 15-month follow-up, the patient was still receiving 5 mg of prednisone a day. BCVA was 20/20 in the RE and 20/25 in the LE. Right fundus was normal (Fig. 3). There was a sunset-glow fundus in the LE associated with RPE changes and a few peripheral nummular atrophic lesions (Fig. 4). There were no recurrences or development of integumentary manifestations. Ocular involvement was isolated in our patient, and therefore, a diagnosis of probable VKH disease was made according to the Revised Diagnostic Criteria for VKH disease [1].Fig. 3


Concurrent acute Vogt-Koyanagi-Harada disease in one eye and chronic disease in the fellow eye.

Khochtali S, Abroug N, Hani MS, Khairallah-Ksiaa I, Jelliti B, Khairallah M - J Ophthalmic Inflamm Infect (2015)

Right color fundus photography at the last follow-up. Fundus photograph of the right eye, 15 months after presentation, shows normal findings
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4558990&req=5

Fig3: Right color fundus photography at the last follow-up. Fundus photograph of the right eye, 15 months after presentation, shows normal findings
Mentions: The patient was given oral prednisone initiated with a dose of 1 mg/kg/day and then gradually tapered over 6 months. In addition to that, she received mycophenolate mofetil (2 mg a day) for a 12-month duration. After a 15-month follow-up, the patient was still receiving 5 mg of prednisone a day. BCVA was 20/20 in the RE and 20/25 in the LE. Right fundus was normal (Fig. 3). There was a sunset-glow fundus in the LE associated with RPE changes and a few peripheral nummular atrophic lesions (Fig. 4). There were no recurrences or development of integumentary manifestations. Ocular involvement was isolated in our patient, and therefore, a diagnosis of probable VKH disease was made according to the Revised Diagnostic Criteria for VKH disease [1].Fig. 3

Bottom Line: The patient received systemic corticosteroids and mycophenolate mofetil.The patient may present only when the fellow eye is affected.A significant delay before involvement of the second eye leads to atypical features of acute disease in one eye and chronic disease in the other eye.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia, khochtali.sana@gmail.com.

ABSTRACT

Background: Vogt-Koyanagi-Harada (VKH) disease is a granulomatous panuveitis, usually involving both eyes at the same time or within a few days or weeks. Acute and chronic diseases are characterized by distinct clinical features, treatment modalities, and visual outcomes. We report an atypical case of probable VKH disease, with features of acute disease in one eye and chronic disease in the fellow eye.

Findings: A 53-year-old female presented with exudative retinal detachment associated with mild vitritis in the right eye and anterior uveitis, vitritis, and sunset-glow fundus in the left eye. Based on clinical findings and results of multimodal imaging including fundus photography, spectral-domain optical coherence tomography, fluorescein angiography, indocyanine green angiography, and B-scan ultrasonography, a diagnosis of acute VKH disease in the right eye and chronic VKH disease in the left eye was made. The patient received systemic corticosteroids and mycophenolate mofetil. After a 15-month follow-up, the right fundus eye was normal, and there was a sunset-glow fundus in the left eye.

Conclusions: VKH disease may begin with asymptomatic unilateral ocular involvement. The patient may present only when the fellow eye is affected. A significant delay before involvement of the second eye leads to atypical features of acute disease in one eye and chronic disease in the other eye.

No MeSH data available.


Related in: MedlinePlus