Vogt-Koyanagi-Harada disease associated with diabetes mellitus and glaucoma

Abstract

Background Vogt-Koyanagi-Harada (VKH) disease is a systemic inflammatory disease affecting the eyes, inner ears, meninges, and skin. Although the exact pathomechanism for VKH has yet to be elucidated, it has been hypothesized that VKH is a T-cell-mediated autoimmune disorder against melanocytes of all organ systems. Diabetes mellitus (DM) has rarely been associated with VKH and glaucoma has frequently occurred as a complication, but not as a preceding event. We present a patient with VKH and DM in whom the glaucoma was the preceding condition.

Case A 59-year-old man was admitted for headache and worsening visual loss bilaterally. Past medical history revealed glaucoma which was diagnosed 6 months ago. His visual loss was rapidly progressive, and was accompanied by headache, tinnitus, and eye ball pain. Decreased visual acuity, visual field defect, neck stiffness, and high-frequency hearing loss were noted. Fundus photography, fundus fluorescein angiography, and optical coherence tomography were performed. Bilateral optic disc edema, serous retinal detachments, and panuveitis were shown. Cerebrospinal fluid analysis disclosed monocytic pleocytosis and mild elevation of protein. On brain MRI, thickening of the posterior globe with enhancement and retrobulbar fat infiltration were shown. Laboratory findings suggested DM. After high dose of steroid treatment was given, his symptom slowly improved.

Conclusions We described a patient with VKH and DM. Glaucoma was diagnosed beforehand. There is growing evidence that the immune system is involved in the pathogenesis of glaucoma. A previous study reported that the high incidence of glucose intolerance was found in acute stage of VKH disease. We should consider that VKH disease may be associated with other autoimmune disorders.