Unusual neurologic manifestations of Vogt-Koyanagi-Harada disease: a systematic literature review

Uveodermatologic syndrome presenting with concurrent aseptic meningoencephalitis in a dog

Canine uveodermatologic syndrome (UDS) resembles human Vogt-Koyanagi-Harada syndrome but typically lacks associated neurological signs. We report a 3-year-old Australian shepherd dog diagnosed with UDS following bilateral enucleation and histopathology. Twelve days postoperatively, neurological symptoms developed, including head tilt, circling, and deafness. Brain MRI and CSF analyses were consistent with meningoencephalitis of unknown etiology (MUE). Oral immunosuppressive therapy (prednisone and cyclosporine) resulted in substantial improvement. Eight months later, during gradual dose reduction, MUE relapsed, prompting an increase in dose to immunosuppressive levels. The dog's death due to an unrelated cause 4 mo later prompted postmortem evaluation. This report adds to the limited literature on MUE associated with UDS in dogs and underscores challenges in diagnosis and management. Literature review suggests this is the second reported case of Vogt-Koyanagi-Harada-like meningoencephalitis in a dog and the first reported case with a confirmed diagnosis via MRI and CSF analyses. Key clinical message: It is important to include UDS as a differential diagnosis for dogs that present with MUE with concurrent ocular and cutaneous signs. For dogs diagnosed with UDS on histology after enucleation, more aggressive immunosuppressive treatment or vigilant monitoring for neurological signs may help prevent or slow progression to neurological involvement.

Choroidal venous overload in Vogt‒Koyanagi‒Harada disease

BACKGROUND/OBJECTIVES

This study aimed to investigate the change of choroidal venous overload in Vogt‒Koyanagi‒Harada (VKH) disease. Clinical records of 52 patients with VKH disease (52 eyes) and 24 control subjects (24 eyes) who underwent multimodal imaging, including fluorescein angiography (FA) and indocyanine green angiography (ICGA), were retrospectively reviewed.

SUBJECTS/METHODS

Imaging data were assessed for signs associated with choroidal venous overload, e.g., choroidal perfusion delay, choroidal vascular hyperpermeability, dilated choroidal veins, and intervortex venous anastomosis (IVA). Dual FA and ICGA scoring for active posterior segment inflammation was performed. Clinical and imaging features associated with choroidal venous overload were compared between early- and late-stage VKH disease.

RESULTS

Choroidal perfusion delay, choroidal vascular hyperpermeability, dilated choroidal veins, and IVA were more prevalent in eyes with VKH disease (69.2%, 67.3%, 61.5%, and 65.4%, respectively) than in control eyes (25.0%, 20.8%, 25.0%, and 37.5%, respectively) (p < 0.05). All eyes with IVA in the early-stage of VKH disease had got other 3 signs. All choroidal venous overload signs were more prevalent in patients with early-stage (20 eyes) than in those with late-stage VKH disease (32 eyes) (p < 0.05). The number of choroidal venous overload signs were inversely related to disease duration (p < 0.001) and proportionally related to the total ICGA score (p < 0.001). IVA was significantly associated with the total ICGA score in logistic regression (p = 0.014).

CONCLUSIONS

Choroidal venous overload occurs early in VKH disease. Angiographic signs of choroidal venous overload may be useful markers to assess the status of VKH disease.