Polyautoimmunity manifest as inflammatory myopathy, uveitis, and progressive cutaneous depigmentation in a mixed breed dog: a case report

BACKGROUND

Polyautoimmunity is the expression of more than one autoimmune disease in a single patient. This report documents polyautoimmunity in a mixed breed dog with concurrent uveitis, cutaneous depigmentation, and inflammatory myopathy.

CASE PRESENTATION

A 1-year-old male neutered mixed breed dog was presented for progressive generalized leukotrichia and leukoderma, bilateral panuveitis, and masticatory muscle atrophy. The latter progressed to myositis of lingual, pharyngeal, and masticatory muscles confirmed by biopsy. Temporalis muscle was completely replaced by adipose and fibrous tissue, and necrotic myofibers with extensive infiltration of mononuclear cells indicated active myositis of lingual muscle. Skin biopsies showed severe melanin clumping in epidermis, hair follicles, and hair shafts, and perifollicular pigmentary incontinence. Uveitis, depigmentation, and myositis affecting the masticatory, pharyngeal, and tongue muscles were diagnosed based on clinical, histological, and laboratory findings.

CONCLUSIONS

To the authors' knowledge, this is the first report of concurrent uveitis, progressive cutaneous depigmentation, and inflammatory myopathy in a dog.

Vogt-Koyanagi-Harada disease following ChAdOx1 nCoV-19 and mRNA-1273 vaccination

Almost all vaccines have been reported to be associated with ocular inflammation, which has caused some concern regarding global mass COVID-19 vaccination efforts. Vogt-Koyanagi-Harada disease (VKHD) is a granulomatous inflammation caused by an autoimmune response against antigens in melanocytes, including those in the eyes. The mechanism by which COVID-19 vaccines are associated with VKHD is still unclear. Here, we report two cases of VKHD following COVID-19 vaccination. The first is a case of probable VKHD that presented with bilateral vision loss after administration of the adenovirus-vectored vaccine ChAdOx1 nCoV-19 (AstraZeneca). The condition improved after intravenous methylprednisolone 1g daily for 3days, followed by oral methotrexate and a slow taper of oral corticosteroids. The second case is a patient with an established diagnosis of well-controlled VKHD who developed a reactivation of the disease after receiving the mRNA-based vaccine (mRNA-1273, Moderna). VKHD is a potential ocular event that could follow COVID-19 vaccination. Awareness of this association is key to early detection and treatment to prevent loss of vision.

Case report: Bilateral panuveitis resembling Vogt-Koyanagi-Harada disease after second dose of BNT162b2 mRNA COVID-19 vaccine

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains a serious pandemic. COVID-19 vaccination is urgent needed for limiting SARS-CoV-2 outbreaks by herd immunity. Simultaneously, post-marketing surveillance to assess vaccine safety is important, and collection of vaccine-related adverse events has been in progress. Vision-threatening ophthalmic adverse events of COVID-19 vaccines are rare but are a matter of concern. We report a 45-year-old Japanese male with positive for HLA-DR4/HLA-DRB1*0405, who developed bilateral panuveitis resembling Vogt-Koyanagi-Harada (VKH) disease after the second dose of Pfizer-BioNTech COVID-19 mRNA (BNT162b2) vaccine. Glucocorticosteroid (GC) therapy combined with cyclosporine A (CsA) readily improved the panuveitis. The immune profile at the time of onset was analyzed using CyTOF technology, which revealed activations of innate immunity mainly consisting of natural killer cells, and acquired immunity predominantly composed of B cells and CD8⁺ T cells. On the other hand, the immune profile in the remission phase was altered by GC therapy with CsA to a profile composed primarily of CD4⁺ cells, which was considerably similar to that of the healthy control before the vaccination. Our results indicate that BNT162b2 vaccine may trigger an accidental immune cross-reactivity to melanocyte epitopes in the choroid, resulting in the onset of panuveitis resembling VKH disease.

De Novo Vogt-Koyanagi-Harada Disease following Covid-19 Vaccine: A Case Report and Literature Overview

PURPOSE

To describe a case of Vogt-Koyanagi-Harada (VKH) disease after a Covid-19 mRNA vaccine (tozinameran) and to present the results of a pharmacovigilance disproportionality study.

METHODS

A retrospective chart review and a pharmacovigilance disproportionality study using the WHO global individual case safety reports database (VigiBase).

RESULTS

A 57-year-old female with no medical history developed a VKH disease 3 weeks after Covid-19 mRNA vaccine. Symptoms at onset were headaches and blurred vision associated with aseptic meningitis and bilateral diffuse granulomatous panuveitis with serous retinal detachment. One month from diagnosis and glucocorticoids treatment, the patient recovered. Five similar cases have been reported in VigiBase. VKH disease is disproportionately reported with tozinameran and other vaccines.

CONCLUSION

VKH disease is disproportionately reported with tozinameran, suggesting a possible safety signal. Cases after vaccination support the screening for any possible immune triggers such as vaccines when assessing patients with VKH disease.

Vogt-Koyanagi-Harada Disease Exacerbation Associated with COVID-19 Vaccine

We describe a case of Vogt-Koyanagi-Harada (VKH) disease exacerbation after COVID-19 vaccination. A 46-year-old woman presented with a bilateral granulomatous uveitis 2 days after the first dose of COVID-19 mRNA vaccine (Comirnaty, Pfizer-BioNTech), and was diagnosed with a complete Vogt-Koyanagi-Harada (VKH) disease 4 days after receiving the second dose of the vaccine. Three weeks before the first dose, she had been consulted for blurred vision and mild headaches. The case resolved with high dose intravenous corticosteroids, followed by oral prednisone. The close temporal relationship between the COVID-19 vaccine doses and the worsening of VKH symptoms strongly suggests COVID-19 vaccination as the trigger of its exacerbation.

Vogt-Koyanagi-Harada Associated with Diabetes Mellitus and Celiac Disease in a 3-Year-Old Girl

Purpose

To present a case of Vogt-Koyanagi-Harada (VKH) associated with type I diabetes mellitus and celiac disease in a 3 year old female.

Methods

We studied a three-year old female who presented with clinical manifestation of VKH and type I Diabetes mellitus and ciliac disease.

Results

Patient was found to have hyperglycemia with type I diabetes mellitus. Duodenal mucosal biopsy specimen confirmed the diagnosis of celiac disease. Patient's ocular inflammation was treated by topical and systemic corticosteroid and immune-suppressive therapy. Her diabetes mellitus was controlled by insulin and her celiac disease was controlled by gluten-free diet.

Conclusions

The association of VKH with two autoimmune diseases (celiac disease and type I diabetes mellitus) is rare. This case is, to our knowledge, the youngest patient reported with VKH.

Label-free proteomics reveals decreased expression of CD18 and AKNA in peripheral CD4+ T cells from patients with Vogt-Koyanagi-Harada syndrome

Vogt-Koyanagi-Harada (VKH) syndrome is a systemic autoimmune disease. CD4⁺ T cells have been shown to be involved in autoimmune diseases including VKH syndrome. To screen aberrantly expressed membrane proteins in CD4⁺ T cell from patients with active VKH syndrome, blood samples were taken from five patients with active VKH syndrome and five healthy individuals. A label-free quantitative proteomic strategy was used to identify the differently expressed proteins between the two groups. The results revealed that the expression of 102 peptides was significantly altered (p<0.05) between two groups and matched amino acid sequences of proteins deposited in the international protein index (ipi.HUMAN.v3.36.fasta). The identified peptides corresponded to 64 proteins, in which 30 showed more than a 1.5-fold difference between the two groups. The decreased expression of CD18 and AKNA transcription factor (AKNA), both being three-fold lower than controls in expression identified by the label-free method, was further confirmed in an additional group of five active VKH patients and six normal individuals using the Western blot technique. A significantly decreased expression of CD18 and AKNA suggests a role for both proteins in the pathogenesis of this syndrome.

Posterior segment recurrences in Vogt-Koyanagi-Harada disease

AIM

To describe the clinical profile, management, and outcome in seven patients with posterior segment recurrence in Vogt-Koyanagi-Harada (VKH) disease.

MATERIAL AND METHODS

Retrospective chart review of all the patients of VKH disease presenting to our institute between 2001 and 2005 was carried out. Patients with a documented posterior segment recurrence during follow-up were included in this study. Their history, systemic associations, ocular findings, investigations, management strategies, and treatment response were noted.

RESULTS

Out of 82 VKH patients screened, documented posterior segment recurrence was seen in seven patients who included five women and two men, with a mean age of 33.7 years (range 22-55 years). At onset, two patients had incomplete and five had probable VKH disease. At the time of recurrence, four patients were on maintenance dose (5-10 mg/day) of oral corticosteroid while the remaining three were off treatment. The mean interval between the primary episode and posterior segment recurrence was 33.7 weeks (range 16-52 weeks). All posterior segment recurrences were bilateral and were characterized by vitritis (eight eyes), papillitis (14 eyes), multiple yellow-white oval subretinal lesions (six eyes), and exudative retinal detachment (10 eyes). The recurrences were managed with oral corticosteroids (1.0-1.5 mg/day) and Azathioprine (2.0-2.5 mg/day). Subsequently, three patients experienced a second episode of posterior segment recurrence, which also responded to the corticosteroid-Azathioprine combination.

CONCLUSIONS

Recurrences in VKH disease may involve predominantly the posterior segment, and respond well to the standard treatment.

Thunderclap headache as initial manifestation of Vogt-Koyanagi-Harada disease

A 59-year-old Asian woman suffered from a TCH followed by sudden, binocular blurred vision, mimicking pituitary apoplexy. The diagnostic workup (including fluorescein angiography, MRI of the brain, and CSF analysis) showed severe optic disc swelling and dye leakage of multiple faint hyperfluorescent spots at retinal pigment epithelium level, diffuse pachymeningeal hypertrophy, and monocytic pleocytosis, respectively. VKH disease should be considered in the differential diagnosis of patients presenting with a TCH followed by sudden, bilateral decreased visual acuity.

Vogt-Koyanagi-Harada Syndrome in a Case of Multiple Sclerosis

A 34-year-old woman in whom multiple sclerosis (MS) had been diagnosed 2 years earlier developed progressive bilateral visual loss associated with peripapillary exudative retinal detachment and other features of Vogt-Koyanagi-Harada (VKH) syndrome. She was treated with corticosteroid pulses and interferon beta-1A with visual acuity improvement and resolution of the retinal detachment. This is the first reported case of VKH syndrome in a patient with MS. The combination of VKH syndrome and MS suggests a common autoimmune pathogenesis.

Interferon-alpha2a and Vogt-Koyanagi-Harada disease: a double-edged sword?

Successful therapy based on the use of interferon-alpha has been reported in different types of severe chronic uveitis. The immunomodulatory effects of this drug, combined with its antiviral properties seem to contribute to its efficacy in the treatment of different forms of severe and refractory uveitis such as Vogt-Koyanagi-Harada disease, Behçet-associated uveitis, or even human herpes virus 8 (HHV-8) associated uveitis. At the same time, severe ocular complications have been reported in patients treated with interferon-alpha for chronic viral hepatitis C. Among these complications, six cases of Vogt-Koyanagi-Harada-like disease have been described.We report a small case series of two patients with refractory Vogt-Koyanagi-Harada disease, treated with interferon-alpha and discuss the potential benefits or detrimental role of interferon therapy in these patients.

[Subacute uveomeningoencephalitis as the presenting symptom of acute infection by the human immunodeficiency virus]

INTRODUCTION

The uveo-meningitic syndrome, or the combination of chronic or recurrent meningitis and acute uveitis, has a specific differential diagnosis. This syndrome can be the clinical debut of systemic disorders, vasculophathies, connective tissue disorders and inmuno-mediated diseases. In patients with AIDS, the syndrome often appears in relation with an opportunist concomitant infection of the central nervous system (CNS).

CASE REPORT

We present one case of subacute uveo-meningitic syndrome as symptomatic presentation of a early infection of HIV. The patient was a man, 37 years-old. He was inmunocompetent and did not know his seropositivity for HIV type 1. We relate the results of the neurologic examination and complementary tests. Only serologic test for HIV type 1 and detection of IgG anti-HIV in cerebrospinal fluid were positives.

CONCLUSIONS

In patients HIV-positive the ocular infection, usually a posterior uveitis, appears together with systemic disorders or central nervous infections. In other hand, the cause of meningitic infection depends on grade of immunocompromise. Aseptic meningitis, for early stages of the disease, is usually no symptomatic. After, opportunist infections or neoplasic infiltration of CNS can be cause of meningoencephalitis. In this patient, the early infection of HIV causes an subacute uveomeningoencephalitis. Early infection of HIV increases the possibilities of aetiological diagnosis of uveomeningitic syndrome.

A case of vogt-koyanagi-harada disease associated with malignant lymphoma

BACKGROUND

Vogt-Koyanagi-Harada disease (VKH), an inflammatory ocular disorder characterized by bilateral granulomatous panuveitis and a variety of extraocular manifestations, has been reported to be associated with various immune disorders but has not been linked to malignant lymphoma (ML).

CASE

We present here a case of VKH associated with a recurrence of ML.

OBSERVATIONS

A 69-year-old man who initially had ML presented with a history of sudden bilateral visual acuity loss. Funduscopy showed papilloedema and serous retinal detachment in both eyes, and a diagnosis of VKH was reached soon thereafter. Chest X-ray and an abdominal computed tomography scan indicated the metastatic focus of the ML. A recurrence was suspected because the ML-associated soluble interleukin-2 receptor (sIL-2R) in the serum was highly elevated. Treatment successfully resolved both the ML and the VKH. The inflammatory activities of VKH and ML were found to correlate with the serum levels of sIL-2R.

CONCLUSIONS

This case suggests an association between sIL-2R levels and disease activity in VKH and ML, and provides additional evidence that VKH can be induced by immune disorders caused by high sIL-2R levels in ML.

Experimentally induced Vogt–Koyanagi–Harada disease in two Akita dogs

We have investigated whether a Vogt-Koyanagi-Harada (VKH)-like disease can be induced in Akita dogs by immunizing them with tyrosinase related protein 1 (TRP1), and compared the alterations induced to those of Akita dogs with a spontaneously occurring disease that resembles human VKH disease. Two Akita dogs were immunized with a peptide mixture of human TRP1. The changes in the eyes were followed by slit-lamp biomicroscopy, ophthalmoscopy, and fluorescein angiography (FA). The eyes, skin, and brains were studied by standard histological methods at about 20 months after the first immunization in one dog (dog 1), and at 3 weeks after the second immunization in the second dog (dog 2). Both dogs developed chorioretinal disease 3-4 weeks after the first immunization. Many inflammatory cells infiltrated into the anterior chamber and anterior vitreous. The fundus showed geographic, multifocal exudative retinal detachments. Multifocal leakages of fluorescein were detected from the choroid. Histologically, exudative retinal detachment was present, and inflammatory cells were seen in the subretinal space in the eyes of dog 2 taken three weeks after the second immunization. The choroid was thickened by the infiltration of inflammatory cells in some lesions. Dalen-Fuchs nodules were seen in the eye of dog 2. Depigmentation, pigment dispersion, and infiltration of many inflammatory cells around hair follicles and vessels were seen in the skin taken three weeks post-immunization. The clinical course and changes in the eyes and skin were very similar to those seen in the Akita dogs with spontaneously occurring VKH disease. We concluded that a VKH-like disease had been induced in these dogs, and this supports the tentative conclusion that the spontaneously occurring chorioretinal disease in Akita dogs is VKH disease.

Almost simultaneous onset of Vogt–Koyanagi–Harada syndrome in co-workers, friends, and neighbors

PURPOSE

To report almost simultaneous onset of Vogt-Koyanagi-Harada (VKH) syndrome in co-workers, friends, and neighbors.

METHODS

The onset of VKH syndrome in six patients was examined.

RESULTS

Patient 1 and Patient 2 worked in the same room of an office and developed VKH syndrome 3 weeks apart from each other. Patient 3 and patient 4 were friends, lived in the same city, and developed VKH syndrome 1 month apart. Patient 5 and patient 6 lived in the same suburb and developed the syndrome 1 month apart.

CONCLUSION

Almost simultaneous onset of VKH syndrome in co-workers, friends, and neighbors may suggest an exogenous factor such as viral infection in the pathogenesis.

Vogt-Koyanagi-Harada syndrome associated with cutaneous malignant melanoma: an 11-year follow-up

PURPOSE

To report a case of Vogt-Koyanagi-Harada (VKH) syndrome associated with cutaneous pigmented malignant melanoma (MM) and non-pigmented nodular metastasis after a 10-year recurrence-free interval.

METHODS

Case report with long-term follow-up of 11 years. Ocular examinations included best-corrected visual acuity (ETDRS charts), fundus photography, fluorescein angiography, and computer-assisted perimetry. In addition, human leukocyte antigen (HLA) typing was performed.

RESULTS

A 48-year-old white female patient developed VKH disease 5 years after she had undergone surgical treatment of a superficial spreading melanoma on her back in 1991. The first symptoms were diffuse alopecia followed by growth of non-pigmented hair after 8 months. In our clinic, she presented 18 months later with cells and opacification in the vitreous, a macular and optic disc edema and atrophy of the retinal pigment epithelium (RPE). The anterior segment showed endothelial precipitates of the cornea, and a progressive secondary cataract. Fluorescein angiography detected a bilateral edema of the macula and the optic disc, and focal leakage in the RPE level. During follow-up the patient developed more cutaneous signs, such as vitiligo-like depigmentation and poliosis. A non-pigmented lymph node MM metastasis was diagnosed after a 10-year disease-free interval. HLA typing was positive for HLA-A*01, HLA-A*24, HLA-B*08, HLA-B*39, HLA-DRB1*03, and HLADRB1*11.

CONCLUSION

Our findings suggest that the described ocular findings of VKH disease may represent a component of a syndrome consisting also of melanoma-associated hypopigmentation. Within the framework of current concepts of immunity in patients with MM and VKH, the long recurrence-free interval might support the hypothesis of an autoimmune or hypersensitivity process against melanocytes. The use of immunosuppressive therapy in the treatment of VKH and its potential influence on the development of metastatic disease should be carefully reconsidered.

Vogt-Koyanagi-Harada disease

Vogt-Koyanagi-Harada disease is a chronic, granulomatous systemic autoimmune disease with manifestations in the ocular, central nervous, auditory, and integumentary systems. The target of attack seems to be antigens associated with melanocytes. Patients are usually of Asian, Middle Eastern, Asian Indian, Native American, or Hispanic ethnicity, and complain of neurologic symptoms quickly followed by decreased vision caused by a choroiditis, frequently with exudative retinal detachments. Corticosteroids are the mainstay of therapy, but other immunosuppressive therapy may be required. Complications, including cataract, glaucoma, choroidal neovascular membrane formation, and subretinal fibrosis, may limit final visual acuity.

Vogt-Koyanagi-Harada syndrome following injury-induced progressive vitiligo

We report a case of Vogt-Koyanagi-Harada (VKH), Syndrome wherein the patient developed ocular symptoms following injury-induced progressive vitiligo with immunologic evidence from the skin biopsy specimen of the vitiligo. This case supports the hypothesis that the cell-mediated immune process against a common melanocyte antigen plays an important role in the development and progression of the disease.

Role of S-100beta as potential autoantigen in an autoimmune disease of the inner ear

In Lewis rats, adoptive transfer of T cells specific for the calcium-binding protein S-100beta mediates experimental autoimmune encephalomyelitis, but surprisingly also induced a marked labyrinthitis associated with impairment of hearing. This suggests that transfer of S-100beta-specific T cells into susceptible animals could be a novel model to study autoimmunity of inner ear diseases. The investigation demonstrated in detail an inner ear involving, central nervous system (CNS)-specific autoimmune disease in order to identify a putatively shared autoantigen(s) in these pathologies. In fact, the model will be a useful tool to investigate in detail, the pathological mechanisms of the human inner ear disease associated with Vogt-Koyanagi-Harada disease.

Vogt-Koyanagi-Harada syndrome after cutaneous injury

OBJECTIVE

To describe three patients who developed Vogt-Koyanagi-Harada syndrome (VKH) after cutaneous injury.

DESIGN

Retrospective case series.

PARTICIPANTS

Three patients seen in the uveitis clinic at Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, India, participated.

MAIN OUTCOME MEASURES

The history, evaluation, and management of the three patients were summarized.

RESULTS

Three patients developed VKH syndrome shortly after cutaneous injury. In each case, the affected area of skin became vitiliginous on healing and simultaneous with the onset of ocular symptoms. One patient developed additional ectopic areas of vitiligo. All three patients developed chronic, bilateral, diffuse uveitis, one associated with an exudative retinal detachment and two with Dalen-Fuchs-like nodules. Well-recognized complications of VKH syndrome that occurred in the authors' patients included geographic atrophy of the retinal pigment epithelium (3 of 3), cataract (3 of 3), and glaucoma (1 of 3). Ocular inflammation was well controlled in each patient with local or systemic corticosteroids or both. In one patient, the area of vitiligo showed increased pigmentation in response to systemic corticosteroid treatment.

CONCLUSIONS

Vogt-Koyanagi-Harada syndrome may follow cutaneous injury, supporting the notion that this disorder may result from systemic sensitization to shared melanocytic antigens.

[Sympathetic ophthalmia versus Harada disease]

An algerian woman presents with a panuveitis of the right eye. Main features of this uveitis are exudative retinal detachments. That happened several months after a corneal ulcer of unknown aetiology on the left eye. Immunologic, neurologic and infections workup associated with previous ocular injury points to the diagnosis of sympathetic ophthalmia. However, the diagnosis of Harada disease can also be considered in this case because of similarities regarding the clinical and the histologic aspects which are exposed. If corticosteroids are the drug of choice, enucleation is still indicated for sympathetic ophthalmia.

Vogt-Koyanagi-Harada syndrome

The Vogt-Koyanagi-Harada syndrome (VKH) is a bilateral, diffuse granulomatous uveitis associated with poliosis, vitiligo, alopecia, and central nervous system and auditory signs. These manifestations are variable and race dependent. This inflammatory syndrome is probably the result of an autoimmune mechanism, influenced by genetic factors, and appears to be directed against melanocytes. On histopathologic examination typical cases show nonnecrotizing diffuse granulomatous panuveitis with initial sparing and late involvement of the choriocapillaris and formation of Dalen-Fuchs' nodules. Fluorescein angiography, lumbar puncture, and echography are useful adjuncts in the diagnosis and management of VKH syndrome. Patients with this syndrome are treated generally with high dose systemic corticosteroids or, when necessary, with cyclosporine or cytotoxic agents. The prognosis of patients with VKH syndrome is fair, with nearly 60% of patients retaining vision of 20/30 or better. The complications of VKH syndrome that lead to visual loss include cataracts in about 25% of patients, glaucoma in 33%, and subretinal neovascular membranes (SRNVMs) in about 10%; the latter, however, are an important cause of late visual loss. These complications usually require medical and/or surgical intervention, including photocoagulation. The major risk factor for the development of cataracts, SRNVMs, and, to some extent, glaucoma, is chronic recurrent intraocular inflammation that may be resistant to corticosteroid therapy. It appears that initial treatment with high dose corticosteroids, combined with prolonged corticosteroid therapy at appropriate dosage, may minimize these complications and may improve visual prognosis.

Vogt-Koyanagi-Harada syndrome complicating allogeneic bone marrow transplantation

Vogt-Koyanagi-Harada (VKH) syndrome is an uncommon acute ophthalmological disorder, characterised by bilateral serous retinal detachment with diffuse choroiditis, in association with specific extra-ocular manifestations. We describe a patient with unequivocal VKH syndrome arising 49 days after matched unrelated donor bone marrow transplantation (BMT) performed as treatment for severe aplastic anaemia. The visual symptoms and retinal changes responded well to corticosteroids. The haematological relevance of VKH syndrome is to distinguish it from retinitis due to cytomegalovirus, which requires different therapy and has a far worse visual prognosis.

Vitiligo and the Vogt-Koyanagi-Harada syndrome

Vitiligo is a common acquired systemic disease that can be associated with several different autoimmune disorders. Besides the psychologically upsetting depigmentation of the skin that it causes, it can be associated with ocular abnormalities. There are three different theories regarding the etiology of vitiligo, none of which is entirely satisfactory. There are some valuable animal models for studying the disease, but they obviously have limitations in their application to the human disease. The melanocyte is present in other areas besides the skin, including the leptomeninges, the retinal pigment epithelium, the uveal tract, and the inner ear. Therefore, it is not surprising that whatever process destroys the melanocyte in the skin can also affect diverse tissues such as the eye, the ear, and the central nervous system. It is postulated that the Vogt-Koyanagi-Harada syndrome may be part of the systemic disease, vitiligo.

[The nervous system and uveitis]

This paper presents a short review of some inflammatory diseases which involve both the nervous system and the uvea, and of some forms of uveitis whose onset could be neurogenic. Multiple sclerosis and reticulum cell sarcoma are examples of systemic neurologic diseases which can be accompanied by uveitis or pseudo-uveitis. Syndromes such as Behçet's or Vogt-Koyanagi-Harada are characterized not only by a highly severe panuveitis but also by the participation of optic nerve, meningeal, and brain tissues in the inflammatory process. The occurrence of sympathetic ophthalmia and herpetic uveitis could to a certain extent be due to a neurogenic transmission of the antigen. For Fuchs' heterochromic cyclitis, however, the old theory of sympathetic nerve dysfunction at its origin is no longer widely accepted.

The Vogt--Koyanagi--Harada syndrome in children

Two cases of the Vogt--Koyanagi--Harada syndrome in children, a very rare disorder in this age group, are reported; one patient had the chronic diffuse type, and the other had neurologic symptoms and exudative retinal detachments. Various theories of causation of the syndrome have been proposed, including viral infection, sympathetic ophthalmia, and altered immunologic status, but the etiology remains obscure.