Vogt-Koyanagi-Harada disease: Study of 14 cases | Medicina Clínica (English Edition)

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We also know it is strongly linked with several haplotypes.<a class="elsevierStyleCrossRef" href="#bib0040">3</a> This disease does not appear to have an identifiable inheritance pattern, although familial cases have been described. It generally affects young adults (20–50 years), mainly females, and is more frequent in pigmented individuals.<a class="elsevierStyleCrossRefs" href="#bib0030">1,2</a>A total of 14 patients (28 eyes) diagnosed with VKH disease were selected (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), 4 men and 10 women, with ages at diagnosis between 15 and 56 years, with an average age of 34 years in the case of men and 29.7 years in the case of women (p=0.97). Twelve (85.7%) patients were Caucasian and 2 were Asian. The mean follow-up was 11.6 years (SD±14.8 years). Two patients were first-line relatives and shared the HLA-DRB1 04 haplotype.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The most common early symptoms were visual disturbances (64.3%), followed by headaches (35.7%). At the time of diagnosis, visual acuity was 0.8 or higher in 7 eyes, and 0.1 or lower in 10 eyes. The major ophthalmologic finding was the occurrence of exudative retinal detachment caused by posterior uveitis (13 patients=92.9%).All patients suffered from panuveitis and/or serous retina detachment. The most common cumulative extraocular manifestations were neurological manifestations (10 patients), followed by auditory (4 patients) and skin manifestations (3 patients). Among the neurological manifestations, the most frequent was recurring headache (70%), followed by loss of feeling in limbs and scalp (18.2%). The most frequent auditory manifestation was tinnitus (75%). Ten of the 14 patients included were diagnosed with incomplete VKH disease, 2 with complete VKH disease and 2 with probable VKH disease.All patients received high-dose systemic corticosteroids during the acute phase of the disease, followed by a 6-month gradual reduction. In 6 of the cases, inflammation was under control with systemic corticosteroid therapy. The rest of the patients required adjuvant therapy. Of the remaining 8 patients, 5 received methotrexate, 2 cyclosporine and 1 azathioprine. A patient with recurrent outbreaks and serious involvement required treatment with biological drugs.Of the 14 patients, 5 did not develop any ocular complications, but 2 of the remaining 8 were diagnosed with cystoid macular edema, 3 with recurrent uveitis, one with band keratopathy, 3 with ocular hypertension and 2 with a choroidal neovascular membrane.VKH disease is one of the major causes of uveitis in Asian countries, which explains why old case series such as Minnakawa et al.<a class="elsevierStyleCrossRef" href="#bib0045">4</a> are included, with a large sample (186 patients). In Spain, this disease has a low prevalence (1.7% of all uveitis).<a class="elsevierStyleCrossRef" href="#bib0035">2</a> Therefore, the largest descriptive studies have included 11 patients.The long follow-up duration of our sample has let us see that the amount of skin changes is the same as the hearing changes, since poliosis and vitiligo are more frequent during convalescence.The majority of patients required adjuvants to corticosteroids, including biological drugs. This shows a significant amount of patients with recurrent or persistent inflammation who might benefit from a more intensive early treatment to prevent sequelae.Although the most widely used immunosuppressant for recurrent inflammatory disease is cyclosporine A 3–5mg/kg/day, the most widely used was methotrexate 10–15mg/week, based on experience with its use in our hospital; and that it has been shown to have comparable success rates.Infliximab was used in one patient, which at a 5mg/kg dose, along with methotrexate 15mg/week, has been shown to be effective in the treatment of posterior uveitis refractory to standard treatment.<a class="elsevierStyleCrossRef" href="#bib0050">5</a>Some of the limitations of our study are the retrospective nature, the reduced sample (due to the rareness of this disease in our environment) and the heterogeneous follow-up.In conclusion, VKH disease is a multisystemic disorder of unknown origin. However, several advances in the last decade have allowed to identify its association with various haplotypes, as well as the association with multiple immune reactions. Because it is a rare disease in our environment, there is little information about its clinical characteristics and spectrum." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Espinosa-Barberi G, Reyes Rodríguez MÁ, Hernández FF. Enfermedad de Vogt-Koyanagi-Harada: estudio de 14 casos. Med Clin (Barc). 2019;152:159–160." ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients (n) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Clinical manifestations</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ophthalmological \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Exudative retinal detachment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85.71 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Panuveítis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.29 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neurological \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.29 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Headaches \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.67 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Loss of sensitivity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.22 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Balance disorders \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Auditory \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.57 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tinnitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vertigo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dermatological \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vitiligo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.33 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Poliosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.33 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Alopecia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.33 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Treatment</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Corticosteroids \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; 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Tejera Segura" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Semin Fund Esp Reumatol" "fecha" => "2012" "volumen" => "13" "paginaInicial" => "142" "paginaFinal" => "146" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vogt-Koyanagi-Harada disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Bonnet" 1 => "J.-B. Daudin" 2 => "D. Monnt" 3 => "A. 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Tagawa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Jpn J Clin Opohthalmol" "fecha" => "1985" "volumen" => "39" "paginaInicial" => "1249" "paginaFinal" => "1253" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of refractory posterior uveitis with infliximab: a 7-year follow-up study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. López-González" 1 => "E. Loza" 2 => "J.A. Jover" 3 => "J.M. Benítez del Castillo" 4 => "R. Méndez" 5 => "C. Hernández-García" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/03009740802366076" "Revista" => array:6 [ "tituloSerie" => "Scand J Rheumatol" "fecha" => "2009" "volumen" => "38" "paginaInicial" => "58" "paginaFinal" => "62" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18991187" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015200000004/v1_201902100719/S2387020618305801/v1_201902100719/en/main.assets" "Apartado" => array:4 [ "identificador" => "43311" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015200000004/v1_201902100719/S2387020618305801/v1_201902100719/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020618305801?idApp=UINPBA00004N"]

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Scientific letter

Vogt-Koyanagi-Harada disease: Study of 14 cases

Enfermedad de Vogt-Koyanagi-Harada: estudio de 14 casos

Glenda Espinosa-Barberia,b,

Corresponding author

glenda_eb@hotmail.com

Corresponding author.

, Miguel Ángel Reyes Rodrígueza, Félix Francisco Hernándezc

a Servicio de Oftalmología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain

b Escuela de Doctorado, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain

c Servicio de Reumatología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain

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    "titulo" => "Vogt-Koyanagi-Harada disease&#58; Study of 14 cases"
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        "titulo" => "Enfermedad de Vogt-Koyanagi-Harada&#58; estudio de 14 casos"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Vogt-Koyanagi-Harada &#40;VKH&#41; disease is an idiopathic disorder that occurs as a bilateral granulomatous panuveitis&#44; accompanied by some changes in the central nervous system&#44; skin and&#47;or ear&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> It was first reported in 1906 by Vogt&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Although it is a disease with an unknown cause&#44; it has been determined that there is a T cell-mediated autoimmune attack against melanocytes&#46; We also know it is strongly linked with several haplotypes&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> This disease does not appear to have an identifiable inheritance pattern&#44; although familial cases have been described&#46; It generally affects young adults &#40;20&#8211;50 years&#41;&#44; mainly females&#44; and is more frequent in pigmented individuals&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A total of 14 patients &#40;28 eyes&#41; diagnosed with VKH disease were selected &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; 4 men and 10 women&#44; with ages at diagnosis between 15 and 56 years&#44; with an average age of 34 years in the case of men and 29&#46;7 years in the case of women &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;97&#41;&#46; Twelve &#40;85&#46;7&#37;&#41; patients were Caucasian and 2 were Asian&#46; The mean follow-up was 11&#46;6 years &#40;SD<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;8 years&#41;&#46; Two patients were first-line relatives and shared the HLA-DRB1 04 haplotype&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The most common early symptoms were visual disturbances &#40;64&#46;3&#37;&#41;&#44; followed by headaches &#40;35&#46;7&#37;&#41;&#46; At the time of diagnosis&#44; visual acuity was 0&#46;8 or higher in 7 eyes&#44; and 0&#46;1 or lower in 10 eyes&#46; The major ophthalmologic finding was the occurrence of exudative retinal detachment caused by posterior uveitis &#40;13 patients<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>92&#46;9&#37;&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">All patients suffered from panuveitis and&#47;or serous retina detachment&#46; The most common cumulative extraocular manifestations were neurological manifestations &#40;10 patients&#41;&#44; followed by auditory &#40;4 patients&#41; and skin manifestations &#40;3 patients&#41;&#46; Among the neurological manifestations&#44; the most frequent was recurring headache &#40;70&#37;&#41;&#44; followed by loss of feeling in limbs and scalp &#40;18&#46;2&#37;&#41;&#46; The most frequent auditory manifestation was tinnitus &#40;75&#37;&#41;&#46; Ten of the 14 patients included were diagnosed with incomplete VKH disease&#44; 2 with complete VKH disease and 2 with probable VKH disease&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">All patients received high-dose systemic corticosteroids during the acute phase of the disease&#44; followed by a 6-month gradual reduction&#46; In 6 of the cases&#44; inflammation was under control with systemic corticosteroid therapy&#46; The rest of the patients required adjuvant therapy&#46; Of the remaining 8 patients&#44; 5 received methotrexate&#44; 2 cyclosporine and 1 azathioprine&#46; A patient with recurrent outbreaks and serious involvement required treatment with biological drugs&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Of the 14 patients&#44; 5 did not develop any ocular complications&#44; but 2 of the remaining 8 were diagnosed with cystoid macular edema&#44; 3 with recurrent uveitis&#44; one with band keratopathy&#44; 3 with ocular hypertension and 2 with a choroidal neovascular membrane&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">VKH disease is one of the major causes of uveitis in Asian countries&#44; which explains why old case series such as Minnakawa et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> are included&#44; with a large sample &#40;186 patients&#41;&#46; In Spain&#44; this disease has a low prevalence &#40;1&#46;7&#37; of all uveitis&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Therefore&#44; the largest descriptive studies have included 11 patients&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The long follow-up duration of our sample has let us see that the amount of skin changes is the same as the hearing changes&#44; since poliosis and vitiligo are more frequent during convalescence&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The majority of patients required adjuvants to corticosteroids&#44; including biological drugs&#46; This shows a significant amount of patients with recurrent or persistent inflammation who might benefit from a more intensive early treatment to prevent sequelae&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Although the most widely used immunosuppressant for recurrent inflammatory disease is cyclosporine A 3&#8211;5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day&#44; the most widely used was methotrexate 10&#8211;15<span class="elsevierStyleHsp" style=""></span>mg&#47;week&#44; based on experience with its use in our hospital&#59; and that it has been shown to have comparable success rates&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Infliximab was used in one patient&#44; which at a 5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg dose&#44; along with methotrexate 15<span class="elsevierStyleHsp" style=""></span>mg&#47;week&#44; has been shown to be effective in the treatment of posterior uveitis refractory to standard treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Some of the limitations of our study are the retrospective nature&#44; the reduced sample &#40;due to the rareness of this disease in our environment&#41; and the heterogeneous follow-up&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In conclusion&#44; VKH disease is a multisystemic disorder of unknown origin&#46; However&#44; several advances in the last decade have allowed to identify its association with various haplotypes&#44; as well as the association with multiple immune reactions&#46; Because it is a rare disease in our environment&#44; there is little information about its clinical characteristics and spectrum&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Espinosa-Barberi G&#44; Reyes Rodr&#237;guez M&#193;&#44; Hern&#225;ndez FF&#46; Enfermedad de Vogt-Koyanagi-Harada&#58; estudio de 14 casos&#46; Med Clin &#40;Barc&#41;&#46; 2019&#59;152&#58;159&#8211;160&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients &#40;<span class="elsevierStyleItalic">n</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleBold">Clinical manifestations</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ophthalmological</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Exudative retinal detachment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Panuve&#237;tis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Neurological</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Headaches&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Loss of sensitivity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Balance disorders&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Auditory</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Tinnitus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Vertigo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Dermatological</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Vitiligo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Poliosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Alopecia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleBold">Treatment</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Corticosteroids</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Methotrexate</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Cyclosporine</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Azathioprine</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Monoclonal antibodies &#40;infliximab&#44; adalimumab and tocilizumab&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;14&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Neovascular membrane</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ocular hypertension</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;43&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 23870206
Original language: English

DOI:10.1016/j.medcle.2018.03.039

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