Vogt-Koyanagi-Harada Disease Diagnosed in a Black-Skinned Woman in Internal Medicine

Abstract

Introduction: Vogt-Koyanagi-Harada disease, initially described as an uveomeningoencephalitic syndrome, is a systemic granulomatous autoimmune disease that targets melanocyte-rich tissues, such as the eye, inner ear, meninges, skin and hair. It is one of the most prevalent causes of noninfectious uveitis affecting, more frequently, individuals of pigmented skin, such as Asians, Middle Easterners, Hispanics and Native Americans. However, it is very infrequent among persons of African descent. Here, we report on a case in a black-skinned woman in internal medicine. Clinical Observation: A 45-year-old Malian black-skinned woman with no history of ocular trauma or intraocular surgery presented at internal medicine outpatient clinic with 3-months history of achromic skin patches over the face and trunk, bilateral visual disturbance, bilateral hearing loss with tinnitus and headache. Dermatological examination revealed bilateral, symmetrical achromic lesions over the back, buttocks and eyelids, with scalp poliosis; and perioral pityriasis versicolor lesions. She had no alopecia or other dermatological lesions. Ophthalmological examination revealed a profound drop in visual acuity. Oto-rhino-laringologic examination revealed a discreet hearing loss. Ophthalmological investigations revealed bilateral posterior panuveitis on funduscopic examination, bilateral chronic iridocyclitis on slit- lamp examination, and bilateral choroidal thickening on ocular ultrasound. The diagnosis of Vogt-Koyanagi-Harada was retained, based on the diagnostic criteria established by the American Society for the Study of Uveitis (UAS) in 1978. Prednisone at a dose of 1.5 mg per kilogram tapering courses with adjuvant treatment was initiated. The ophthalmologist's prescription consisted of 1% atropine eye drops, 0.25% timoptol eye drops and dexamethasone eye drops which had been discontinued because of systemic cortitherapy; and that of the dermatologist, Hydrocortisone butyrate 0.1% cream, .......