Korean J Ophthalmol.  2009 Jun;23(2):112-113. 10.3341/kjo.2009.23.2.112.

A Case of Vogt-Koyanagi-Harada Disease in a Patient With Graves Disease

• Seo JH
• Yu HG
• Chung H

• KMID: 754728
• DOI: http://doi.org/10.3341/kjo.2009.23.2.112

Abstract

A case of Vogt-Koyanagi-Harada disease (VKH) that developed in a 36-year-old woman with Graves' disease was described. The patient was treated with Lugol's solution and presented with bilateral serous retinal detachment. She had also suffered from methimazole-induced hypersensitivity and steroid-induced myopathy. Fluorescein angiography showed multiple leakage points and a lumbar puncture revealed pleocytosis, which was compatible with VKH. High dose steroid pulse therapy was successful. Altered immune regulation associated with drug-induced hypersensitivity may contribute to the development of VKH in patients with Graves' disease.

Keyword

Drug-induced hypersensitivity; Graves' disease; Hyperthyroidism; Iodine therapy; Vogt-Koyanagi-Harada disease

MeSH Terms

Adult
Coloring Agents/administration & dosage
Diagnosis, Differential
Dose-Response Relationship, Drug
Drug Therapy, Combination
Female
Fluorescein Angiography
Follow-Up Studies
Fundus Oculi
Glucocorticoids/administration & dosage
Graves Disease/*complications/diagnosis/drug therapy
Humans
Immunosuppressive Agents/administration & dosage
Injections, Intravenous
Iodides/administration & dosage
Ophthalmic Solutions/administration & dosage
Uveomeningoencephalitic Syndrome/*complications/diagnosis/drug therapy

Figure

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  Fig. 1 Fundus photography, fluorescein angiography (FAG) and optical coherence tomography (OCT) performed at the initial visit. At that time, predisolone dosage was 10 mg. (A and B) Fundus photography of both eyes. (C and D) FAG showed multiple leakage points. (E and F) OCT showed subretinal fluid affecting macula.

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  Fig. 2 Fluorescein angiography (FAG) and indocyanine green angiography (ICG) performed after 1 week of close observation using 5 mg predisolone under the impression of steroid induced central serous retinopathy. Anterior chamber reaction with vitritis developed. (A and B) FAG showed multiple pin point size leakages. (C and D) ICG showed multiple hypofluorescent spots.

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  Fig. 3 Fundus photography, fluorescein angiography (FAG) and optical coherence tomography (OCT) performed 4 weeks later. After high-dose steroid (500 mg methylpredisolone) pulse therapy, the patient was given 30 mg predisolone with 75 mg of cyclosporine. (A and B) Fundus photography of both eyes. (C and D) FAG showed the multiple leakages point had disappeared. (E and F) OCT showed that subretinal fluid.

Reference

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