Vogt-Koyanagi-Harada Disease an Autoimmune Comorbidity of Multiple Sclerosis, Not Just a Mimicker
Milena Lobaina1, Vijaya Lakshmi Valaparla1, Elena Shanina2
1Neurology, University of Texas Medical Branch, 2Neurology, University of Texas Medical Branch, Neurology Department
Objective:
To understand the potential overlapping features among Vogt-Koyanagi-Harada disease (VKHD) and multiple sclerosis, which are crucial in evaluating and treating patients with potential MS diagnoses.
Background:
VKHD is a very rare systemic granulomatous autoimmune disorder known as uveomeningoencephalitis, commonly affecting pigmented tissues. While autoimmune comorbidities are described in MS, the coexistence of MS and VKHD has been reported in the literature only once. VKHD is reported in several cases as a mimicker of MS due to its CNS manifestations. Both diseases can present with painful visual loss, focal neurological deficit, and scattered white matter lesions on MRI. However, panuveitis, pigmental retinal changes, exudative retinal detachment, mild CSF pleocytosis without oligoclonal bands, and leptomeningeal and pachymeningeal enhancement on imaging are typical findings in VKHD.
Results:
A 23-year-old Hispanic female with recently diagnosed MS presented with rapidly progressing bilateral painful vision loss, photophobia, and right-sided weakness. The diagnosis of MS was made based on the revised McDonald criteria. She had oligoclonal bands in CSF and multiple T2-FLAIR hyperintense, T1-hypointense, and gadolinium-enhancing lesions in the juxtacortical, periventricular locations and cerebellum. Her ophthalmological evaluation showed bilateral panuveitis, optic disk edema, and retinal and choroidal pigmental changes, typical for VKHD. MRI orbits revealed left optic nerve enhancement and bilateral posterior choroidal thickening. A thorough workup excluded other infectious and inflammatory etiologies. The patient received treatment with a pulse dose of corticosteroids followed by taper, plasmapheresis, and glatiramer acetate, with gradual improvement in her vision.
Conclusions:
VKHD can mimic MS and can coexist as an autoimmune comorbidity. Careful analysis of the clinical presentation, symptoms evolution, laboratory and radiological findings, and an appropriate ophthalmological evaluation are crucial in diagnosing either condition. Knowledge of these two autoimmune conditions' potential association and unique, distinguishable characteristics will allow clinicians to diagnose and manage patients appropriately.