Vogt-Koyanagi-Harada Syndrome Diagnosed at the Sequellar Stage in an 11-Year-Old Child: A Case Report

Abstract

Vogt-Koyanagi-Harada syndrome is a severe granulomatous panuveitis associated with neuromeningeal, dermatologic, and auditory extraocular manifestations. Uveitis in children accounts for only 5-10% of all uveitis. Vogt-Koyanagi-Harada syndrome is an even rarer cause. The exact etiology remains unknown, however, a genetic predisposition to an autoimmune process directed against melanocytes is incriminated. We report the case of an 11-year-old child with a history of recurrent red eyes with episodes of headache accompanied by dizziness who consulted us for a painful red eye with decreased visual acuity. In view of the clinical and paraclinical anamnestic elements and based on the diagnostic criteria of the Vogt-Koyanagi-Harada syndrome of the American Uveitis Society revised in 2001, the diagnosis of a VKH syndrome in its complete form was retained. Treatment with 3 boluses of methylprednisolone (1 g/1.73m2) over three days was initiated, followed by oral therapy combined with topical corticosteroids and cycloplegic therapy. The long-term evolution was marked by recurrences of the previous uveitis, and the patient was put on immunosuppressive treatment with mycophenolate mofetil (30 mg/kg per day in two doses). Although rare, VKH syndrome exists in the pediatric population. Our observation highlights the diagnostic difficulties associated with this condition. We insist on the usefulness of a thorough history in order to retrace the history of the disease and on the necessity of an early diagnosis and treatment to guarantee a better prognosis.