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 patie...

Full description

Bibliographic Details
Main Authors: Ioannis Papasavvas, Carl P. Herbort
Format: Article
Language:English
Published: SpringerOpen 2021-07-01
Series:Journal of Ophthalmic Inflammation and Infection
Subjects:
Online Access:https://doi.org/10.1186/s12348-021-00251-5
_version_ 1818665419319279616
author Ioannis Papasavvas
Carl P. Herbort
author_facet Ioannis Papasavvas
Carl P. Herbort
author_sort Ioannis Papasavvas
collection DOAJ
description 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.
first_indexed 2024-12-17T05:48:20Z
format Article
id doaj.art-7de2004868dd4876807679dbff289567
institution Directory Open Access Journal
issn 1869-5760
language English
last_indexed 2024-12-17T05:48:20Z
publishDate 2021-07-01
publisher SpringerOpen
record_format Article
series Journal of Ophthalmic Inflammation and Infection
spelling doaj.art-7de2004868dd4876807679dbff2895672022-12-21T22:01:13ZengSpringerOpenJournal of Ophthalmic Inflammation and Infection1869-57602021-07-011111610.1186/s12348-021-00251-5Reactivation of Vogt-Koyanagi-Harada disease under control for more than 6 years, following anti-SARS-CoV-2 vaccinationIoannis Papasavvas0Carl P. Herbort1Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Teaching Centre Clinic MontchoisiRetinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Teaching Centre Clinic MontchoisiAbstract 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.https://doi.org/10.1186/s12348-021-00251-5Vogt-Koyanagi-Harada disease: Indocyanine green angiographyAutoimmune stromal choroiditisAnti-SARS-CoV-2 vaccination
spellingShingle Ioannis Papasavvas
Carl P. Herbort
Reactivation of Vogt-Koyanagi-Harada disease under control for more than 6 years, following anti-SARS-CoV-2 vaccination
Journal of Ophthalmic Inflammation and Infection
Vogt-Koyanagi-Harada disease: Indocyanine green angiography
Autoimmune stromal choroiditis
Anti-SARS-CoV-2 vaccination
title Reactivation of Vogt-Koyanagi-Harada disease under control for more than 6 years, following anti-SARS-CoV-2 vaccination
title_full Reactivation of Vogt-Koyanagi-Harada disease under control for more than 6 years, following anti-SARS-CoV-2 vaccination
title_fullStr Reactivation of Vogt-Koyanagi-Harada disease under control for more than 6 years, following anti-SARS-CoV-2 vaccination
title_full_unstemmed Reactivation of Vogt-Koyanagi-Harada disease under control for more than 6 years, following anti-SARS-CoV-2 vaccination
title_short Reactivation of Vogt-Koyanagi-Harada disease under control for more than 6 years, following anti-SARS-CoV-2 vaccination
title_sort reactivation of vogt koyanagi harada disease under control for more than 6 years following anti sars cov 2 vaccination
topic Vogt-Koyanagi-Harada disease: Indocyanine green angiography
Autoimmune stromal choroiditis
Anti-SARS-CoV-2 vaccination
url https://doi.org/10.1186/s12348-021-00251-5
work_keys_str_mv AT ioannispapasavvas reactivationofvogtkoyanagiharadadiseaseundercontrolformorethan6yearsfollowingantisarscov2vaccination
AT carlpherbort reactivationofvogtkoyanagiharadadiseaseundercontrolformorethan6yearsfollowingantisarscov2vaccination