Vogt-Koyanagi-Harada disease is always bilateral: reports of unilateral cases failed to use choroidal investigations showing subclinical involvement of the fellow eye
Abstract Background/purpose Vogt-Koyanagi-Harada (VKH) disease is a primary stromal choroiditis and a bilateral granulomatous panuveitis which, if not treated early and properly, could have a deleterious evolution. The purpose of our case report is to demonstrate that “so called” unilateral VKH dise...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2021-02-01
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| Series: | Journal of Ophthalmic Inflammation and Infection |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12348-021-00237-3 |
| _version_ | 1819180855587766272 |
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| 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 and a bilateral granulomatous panuveitis which, if not treated early and properly, could have a deleterious evolution. The purpose of our case report is to demonstrate that “so called” unilateral VKH disease should be investigated further with an Indocyanine Green Angiography (ICGA), in order to detect subclinical choroidal involvement of the other eye. Case report We present a case of 42-year old woman who came to see us for second opinion. She had consulted elsewhere for a left uveitis and had been treated with a periocular corticosteroid injection. At presentation she mentioned persistent headaches. Visual acuity on the Snellen scale was 1.0 OD and 0.5 OS. Slit-lamp examination showed granulomatous (rare mutton-fat KPs) signs in her left eye. Laser flare photometry showed a subclinical flare of 17.8 ph/ms OD and a flare of 66.4 ph/ms OS (normal values 3–6 ph/ms). Fundus examination showed left discoloration due to choroidal infiltration with a normal fundus aspect OD. ICGA showed a diffuse choroiditis also in the apparently normal right eye. Lumbar puncture confirmed the diagnosis of VKH and appropriate treatment was introduced. Conclusion VKH disease results from a generalized autoimmune process against melanocyte associated antigens starting in the choroidal stroma. It can be asymmetrical but is always bilateral, as long as investigations such as ICGA, able to detect subclinical choroiditis, are performed. |
| first_indexed | 2024-12-22T22:20:58Z |
| format | Article |
| id | doaj.art-ec7b9522888d4ce5bc0e2672cdbefd91 |
| institution | Directory Open Access Journal |
| issn | 1869-5760 |
| language | English |
| last_indexed | 2024-12-22T22:20:58Z |
| publishDate | 2021-02-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Journal of Ophthalmic Inflammation and Infection |
| spelling | doaj.art-ec7b9522888d4ce5bc0e2672cdbefd912022-12-21T18:10:40ZengSpringerOpenJournal of Ophthalmic Inflammation and Infection1869-57602021-02-011111710.1186/s12348-021-00237-3Vogt-Koyanagi-Harada disease is always bilateral: reports of unilateral cases failed to use choroidal investigations showing subclinical involvement of the fellow eyeIoannis 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 and a bilateral granulomatous panuveitis which, if not treated early and properly, could have a deleterious evolution. The purpose of our case report is to demonstrate that “so called” unilateral VKH disease should be investigated further with an Indocyanine Green Angiography (ICGA), in order to detect subclinical choroidal involvement of the other eye. Case report We present a case of 42-year old woman who came to see us for second opinion. She had consulted elsewhere for a left uveitis and had been treated with a periocular corticosteroid injection. At presentation she mentioned persistent headaches. Visual acuity on the Snellen scale was 1.0 OD and 0.5 OS. Slit-lamp examination showed granulomatous (rare mutton-fat KPs) signs in her left eye. Laser flare photometry showed a subclinical flare of 17.8 ph/ms OD and a flare of 66.4 ph/ms OS (normal values 3–6 ph/ms). Fundus examination showed left discoloration due to choroidal infiltration with a normal fundus aspect OD. ICGA showed a diffuse choroiditis also in the apparently normal right eye. Lumbar puncture confirmed the diagnosis of VKH and appropriate treatment was introduced. Conclusion VKH disease results from a generalized autoimmune process against melanocyte associated antigens starting in the choroidal stroma. It can be asymmetrical but is always bilateral, as long as investigations such as ICGA, able to detect subclinical choroiditis, are performed.https://doi.org/10.1186/s12348-021-00237-3Vogt-Koyanagi-Harada diseaseIndocyanine green angiographyAutoimmune stromal choroiditis |
| spellingShingle | Ioannis Papasavvas Carl P. Herbort Vogt-Koyanagi-Harada disease is always bilateral: reports of unilateral cases failed to use choroidal investigations showing subclinical involvement of the fellow eye Journal of Ophthalmic Inflammation and Infection Vogt-Koyanagi-Harada disease Indocyanine green angiography Autoimmune stromal choroiditis |
| title | Vogt-Koyanagi-Harada disease is always bilateral: reports of unilateral cases failed to use choroidal investigations showing subclinical involvement of the fellow eye |
| title_full | Vogt-Koyanagi-Harada disease is always bilateral: reports of unilateral cases failed to use choroidal investigations showing subclinical involvement of the fellow eye |
| title_fullStr | Vogt-Koyanagi-Harada disease is always bilateral: reports of unilateral cases failed to use choroidal investigations showing subclinical involvement of the fellow eye |
| title_full_unstemmed | Vogt-Koyanagi-Harada disease is always bilateral: reports of unilateral cases failed to use choroidal investigations showing subclinical involvement of the fellow eye |
| title_short | Vogt-Koyanagi-Harada disease is always bilateral: reports of unilateral cases failed to use choroidal investigations showing subclinical involvement of the fellow eye |
| title_sort | vogt koyanagi harada disease is always bilateral reports of unilateral cases failed to use choroidal investigations showing subclinical involvement of the fellow eye |
| topic | Vogt-Koyanagi-Harada disease Indocyanine green angiography Autoimmune stromal choroiditis |
| url | https://doi.org/10.1186/s12348-021-00237-3 |
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