Abstract

Introduction To describe the characteristics, diagnosis, and treatment of the first documented case of Vogt–Koyanagi–Harada (VKH) disease following BCG vaccination (Patient 1) and the first documented case of both VKH disease and tuberculosis (Patient 2).Two patients were diagnosed with VKH disease and monitored using fundus photography, fundus autofluorescence, fluorescein angiography (FA), spectral-domain optical coherence tomography, and enhanced depth imaging optical coherence tomography (EDI-OCT).Case description A 39-year-old patient (Patient 1) had bilateral granulomatous anterior uveitis and serous retinal detachment. FA showed multiple punctuate hyperfluorescent lesions and multilobular pools of dye. EDI-OCT revealed serous retinal detachment, subretinal septa, and cystoid spaces. A 40-year-old woman (Patient 2) presented with a 3-week history of decreased vision, headache and tinnitus. Fundus examination showed bilateral disc swelling with serous retinal detachment and retinal folds. She had been diagnosed with tuberculosis. EDI-OCT showed fluctuation of the internal limiting membrane (ILM), retinal folds, retinal pigment epithelial (RPE)-Bruch membrane undulation, choroidal folds, serous retinal detachment. Both of the patients received high dosage of steroid treatment during the diagnosis. A fast recovery in VKH symptoms was observed following the treatment.Discussion and evaluationImmunological mechanisms and dysregulation of the immune system may play a significant role in the association between VKH disease and BCG.ConclusionsEDI-OCT imaging demonstrated structural changes in the photoreceptor layer, RPE-Bruch membrane, choroid, outer retina, ILM in acute VKH.

Highlights

  • To describe the characteristics, diagnosis, and treatment of the first documented case of Vogt–Koyanagi–Harada (VKH) disease following BCG vaccination (Patient 1) and the first documented case of both VKH disease and tuberculosis (Patient 2).Two patients were diagnosed with VKH disease and monitored using fundus photography, fundus autofluorescence, fluorescein angiography (FA), spectral-domain optical coherence tomography, and enhanced depth imaging optical coherence tomography (EDI-OCT).Case description: A 39-year-old patient (Patient 1) had bilateral granulomatous anterior uveitis and serous retinal detachment

  • Dogan et al SpringerPlus (2016) 5:603 retinal pigment epithelium (RPE), the subretinal space is filled with an eosinophilic exudate of proteinaceous material, and the choroid is diffusely infiltrated by lymphocytes, with focal aggregates of epithelioid histiocytes and multinucleated giant cells

  • These findings indicate the existence of an immune mechanism against melanocytes accompanied by antigenic peptides accompany and managed by T-lymphocytes (Rao 1997)

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Summary

Background

Vogt–Koyanagi–Harada (VKH) disease is a rare granulomatous inflammatory disorder affecting the eyes, auditory system, meninges and skin. H EDI-OCT image of the left eye shows decrease in serous retinal detachment and complete resolution of subretinal cystoid spaces. Three months after the start of steroid therapy, color fundus photos showed disappearance of serous retinal detachment with disc swelling and retinal folds (Fig. 7a, b), FA showed minimal optic disc hyperfluorescence (Fig. 7c, d), and EDI-OCT confirmed complete resolution of serous retinal detachment and RPE-Bruch membrane undulation (Fig. 7e, f ). Her best-corrected visual acuity (BCVA) was 20/20 in both eyes. About 2–3 months after the onset of VKH, vitiligo occurred on the face

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