Characteristics of patients with Vogt Koyana Harada disease of Hospital de Clinicas Rheumatology Department

Abstract

Introduction: Vogt-Koyanagi-Harada´s disease (VKHD) is a bilateral, diffuse and chronic granulomatous panuveitis characterized by serous retinal detachment. This disease is often associated with neurological, auditory and dermatological disorders. Objetive: To describe the characteristics of patients with VKHD in our rheumatology service. Methods: Retrospective study based on the review of medical records of patients with a diagnosis of VKH who are being followed by the Department of Rheumatology of Hospital de Clínicas of FCM – UNA from 2000 until 2015. Results: We reviewed 3727 clinical records of which 8 patients with VKH were identified. Mean age at diagnosis was 44.6 ± 8.8 years. All of these patients were referred to the clinic for decreased visual acuity. Six patients (75 %) had serous retinal detachment. Dermatologic symptoms were found in 2/8 (25 %) patients and auditory symptoms were present in 2/8 (25 %) patients as well. General symptoms such as malaise and fever were present in 1/8 (12.5 %) patient. Neurological alterations were observed in 3/8 (37.5 %) patients. All patients received high doses of systemic glucocorticoids and 2/8 (25 %) of the patients also received NSAIDs. Of the total number of patients, 3/8 (37.5 %) received cyclophosphamide, 5/8 (62.5 %) azathioprine and 1/8 (12.5%) methotrexate. Some patients received more than one immunosuppressant. The final visual acuity improved in 75% (6/8) of the cases, but 2/8 (25 %) of them had poor visual outcome. Ocular complications such as cataracts were seen in 2/8 (25 %) of patients. Synechiae and glaucoma were seen in an equal amount (25 %). In-band keratitis was found in 1/8 (12.5 %) patient. No patient required vitrectomy or developed ocular hypotension. Conclusion: All patients required immunosuppressants and most of the patients had a favorable outcome. The clinical manifestations and the female predominance coincide with the current literature. Our cases reaffirm the fact that with early and aggressive management, the prognosis of this disease is favorable.