|Year : 1992 | Volume
| Issue : 5 | Page : 340-342
Vogt koyanagi harada syndrome
VK Srivastava, A Shadab Khan
V K Srivastava
Source of Support: None, Conflict of Interest: None
A case of Vogt Koyanagi Harada syndrome is reported. The depigmented macules appeared initially over eyebrows and around both eyes after an episode of fever and then rapidly involved almost the entire body within 6 months.
Keywords: Vogt Koyanagi Harada syndrome, Vitiligo, Poliosis
|How to cite this article:|
Srivastava V K, Khan A S. Vogt koyanagi harada syndrome. Indian J Dermatol Venereol Leprol 1992;58:340-2
| Introduction|| |
Vogt Koyanagi Harada syndrome is a rare multisystem disease characterised by bilateral, nontraumatic uveitis, poliosis, vitiligo, and aseptic meningitis.  The disease often begins with vitiligo in the vicinity of eyes and then may spread to involve other sites. It has a protracted course, responds poorly to treatment and usually terminates in partial or complete blindness. 
| Case Report|| |
A 30-year-old male patient presented with mild grade off and on fever, headache, photophobia, eye pain, gradual diminution of vision in both eyes, and impairment of hearing from last 6 months. This was followed by sudden development of multiple asymptomatic depigmented macules around both eyelids, eyebrows, cheeks, and other body areas. Patient was conscious, alert and had no other neurosurgical abnormalities. His family history was not significant.
On examination he had multiple depigmented macules around both eyelids and eyebrows, and on cheeks [Figure - 1]. Poliosis of both eye lashes and eye brows was present. He also had multiple depigmented macules distributed in a bilateral symmetrical manner over both extremities and trunk [Figure - 2].
Routine blood and CSF investigations were normal. CT scan of brain was normal, Audiometry was also normal and the ophthalmic examination showed finger counting at 1.5 metres with chronic active iridocyclitis in both eyes.
Histopathological examination of the skin tissue from a depigmented macule showed atrophic epidermis, complete absence of melanocytes with occasional presence of a few Langerhan cells. There was a lymphocytic infiltrate in the superficial dermis and some of the lymphocytes were lying in close contact with the basal layer. Overall picture was consistent with the clinical diagnosis of vitiligo. The patient was given Desican and Cortisone eye drops, and systemic steroids. He had definite improvement in his visual acuity within a month.
| Comments|| |
Vogt Koyanagi Harada syndrome is often attributed to be a viral or an autoimmune disorder.  Initially there are prodromal symptoms of meningocephalic phase characterised by fever, malaise, headache, nausea etc.. In our case the patient initially had mild grade fever probably of viral origin which was followed by iridocyclitis, hearing impairment and multiple depigmented macules. Besides this the presence of lymphocytic infiltrate in close contact with the basal layer in superficial dermis suggested an immunologic phenomenon. ,
The sudden development of depigmented macules over most of the body areas within a week with bilateral symmetrical distribution along with symmetrical poliosis, iridocyclitis, and hearing impairment suggested the diagnosis in our case.
| References|| |
|1.||Nordlung J, Albert D, Forget B, Lerner AB. Halo nevi and the Vogt Koyanagi Harada syndrome: manifestation of vitiligo. Arch Dermatol 1980; 116: 690-2. |
|2.||Rosen E. Uveitis with poliosis, vitiligo, alopecia and dysacousia (Vogt Koyanagi Syndrome). Arch Opthalmol 1945; 33: 281-92. |
|3.||Howsden SM, Herndon JH Jr, Freeman RG.Vogt Koyanagi Harada Syndrome and psoriasis. Arch Dermatol 1973; 108: 395-8. [PUBMED] |
|4.||Bazes A, Balas D, Bazex J. Maladie de Vogt Koyanagi Harada. Ann Dermatol Venerol 1977; i 104:849-53. |
|5.||Klans S, Moellmann G. Proceedings of first International Workshop on Vitiligo. J Invest Dermatol 1978; 71: 165. |
[Figure - 1], [Figure - 2]
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