Vogt-Koyanagi-Harada: treatment of recurrence after administration of 3 intravenous bolus of 1 g of corticosteroids and mycophenolate mofetil

Abstract

The case is presented on a young Honduran female with no medical history of note, who presented with multiple areas of exudative retinal detachment (RD), and a best-corrected visual acuity of 1.3 logMAR in both eyes. She was diagnosed with incomplete Vogt-Koyanagi-Harada syndrome, and treated early with a combination of intravenous therapy with 1 g of prednisolone per day for 3 days, as recommended by published evidence, as well as mycophenolate mofetil (2 g per day). During the corticosteroids tapering, there was a recurrence of exudative retinal detachments, and megadoses of 1 g of intravenous corticosteroids per day were reintroduced for 6 days until the complete resolution of the fluid of the exudative RD, and cyclosporine (100 mg per day), subtenon triamcinolone (40 mg/mL), and intravitreal ranibizumab once a month in the both eyes were added to the treatment, with a great control of choroidal inflammation that resulted in the remission of symptoms and signs.

Resumen

Presentamos el caso de una mujer hondureña de 27 años sin antecedentes médicos de interés que presentó múltiples áreas de desprendimientos de retina (DR) exudativos y una una mejor agudeza visual corregida (MAVC) de 1.3 logMAR en ambos ojos (AO). Fue diagnosticada de Síndrome de Vogt-Koyanagi-Harada (VKH) incompleto y tratada con prednisolona intravenosa (1 g / 24 horas) durante 3 días, tal y como recomienda la evidencia publicada, junto con micofenolato de mofetilo (MMF) (2 g / 24 horas). Durante el descenso paulatino de corticoesteroides, los DR recidivaron, por lo que se reintrodujeron las megadosis de 1 g / 24 horas de corticoesteorides intravenosos durante 6 días hasta la resolución completa de los DR y se añadiron ciclosporina (100 mg / 24 horas), triamcinonolona subtenoniana (40 mg/mL) e inyecciones intravítreas mensuales de ranibizumab en AO, con un adecuado control de la inflamación coroidea que se tradujo en la remisión de los síntomas y signos.