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Unusual association of diseases/symptoms
Case report
Unique clinical spectrum with distinguishing diagnostic features in Vogt-Koyanagi-Harada syndrome
  1. Mamoona Sultan1,
  2. Adeena Khan2,
  3. Syed Shahid Habib3 and
  4. Dheyab Abdulsalam4
  1. 1Internal Medicine, King Saud University, Riyadh, Saudi Arabia
  2. 2Radiology, King Saud University, Riyadh, Saudi Arabia
  3. 3Clinical Physiology, King Saud University, Riyadh, Saudi Arabia
  4. 4Ophthalmology, King Saud University, Riyadh, Saudi Arabia
  1. Correspondence to Dr Adeena Khan; khan.adeena{at}yahoo.com

Abstract

A 36-year-old ulcerative colitis male patient on treatment for 7 years was referred to dermatology with resistant alopecia universalis and hypopigmented patches on limbs for 5 months. During this time he also reported to ophthalmology with acute bilateral decreased vision for 5 days. His examination revealed hyperaemic discs, multifocal retinal detachments and choroidal granulomas. Taking into account the revised diagnostic criteria, atypical course of disease in the form of early cutaneous presentation followed by ophthalmic manifestations was attributed to Vogt-Koyanagi-Harada syndrome (VKHS) which was supported by relevant investigations including ophthalmic imaging, MRI and nerve conduction studies. Subclinical nerve conduction abnormalities and white matter demyelination were also seen for the first time in a patient of VKHS. Appropriate treatment was required to prevent visual complications; therefore, systemic corticosteroids with steroid sparing immunosuppressive drug therapy showed significant improvement in vision on follow-up. Cutaneous manifestations were resilient to the entire regimen.

  • immunology
  • dermatology
  • ulcerative colitis
  • neuroimaging
  • peripheral nerve disease

https://doi.org/10.1136/bcr-2019-231397

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    Footnotes

    • Contributors MS planned the case report, wrote all the clinical part of manuscript and analysed the clinical manifestations of the patient with final review of manuscript. AK interpreted MRI of the patient, wrote the radiological part of manuscript, did computer work and final review of the manuscript. SSH analysed the nerve conduction studies with its description and also did critical analysis of the final manuscript. DA evaluated eye images and wrote the opthalmological part of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Ethics approval Taken

    • Provenance and peer review Not commissioned; externally peer reviewed.