METHOTREXATE FOR REBOUND PHENOMENON OF VOGT-KOYANAGI-HARADA IN JUVENILE: A RARE CASE REPORT
Article Sidebar
-
Juvenile Vogt-Koyanagi-Harada, Steroid Sparing Agents, Rebound Phenomenon, Methotrexate
Abstract
Introduction: Vogt-Koyanagi-Harada (VKH), an auto-immune disorder driven by melanocyte antigen, is rare in children. The mainstay treatments are corticosteroid and immunomodulators. Methotrexate is one of immunomodulator that widely used due to its effectiveness with minimal side effects.
Case Report: A 9-years-old boy get diagnosed Vogt-Koyanagi-Harada. His best corrected visual acuities (BCVA) were 20/400 in both eyes. Anterior segment examination showed granulomatous uveitis. Posterior segment examination revealed optic disk swelling, Dallen Fuch’s nodule and exudative retinal detachment. We also found poliosis and vitiligo in his lips. He had been previously treated with topical corticosteroids, oral corticosteroids and topical cycloplegics. The dose was tapered every month. After taking medication for 5 months with the last dose oral corticosteroid 16 mg/day and topical corticosteroid every 8 hours, his BCVA recovered to 20/25 RE and 20/40 LE. During the treatment time, the patient discontinued the medication due to parental disobedience and then came with decrease of vision. Based on the consideration of rebound phenomenon and the use of maximum dose of corticosteroids, we consulted the patient to the pediatrician, and decided to give methotrexate as an immunosuppressant. After receiving 15 mg/week of methotrexate for 3 months, inflammation calmed down but unfortunately the vision did not improve.
Discussion: In children, the main treatment for VKH disease is high-dose corticosteroids. Considering the side effects of prolonged systemic corticosteroid therapy, methotrexate become the first line of corticosteroid sparing agent, especially in chronic stage.
Conclusion: Methotrexate can be an effective treatment option for rebound VKH.
Keywords: Juvenile Vogt-Koyanagi-Harada, Steroid Sparing Agents, Rebound Phenomenon, Methotrexate.
Full text article
References
O'Keefe GA, Rao NA. Vogt-Koyanagi-Harada disease. Surv Ophthalmol. 2017;62:1–25.
R. W. Read, G. N. Holland, N. A. Rao et al., “Revised diagnostic criteria for Vogt-Koyanagi-Harada disease: report of an international committee on nomenclature,” American Journal of Ophthalmology, vol. 131, no. 5, pp. 647–652, 2021.
Abu El-Asrar AM, Al-Kharashi AS, Aldibhi H, Al-Fraykh H, Kangave D. Vogt-Koyanagi-Harada disease in children. Eye (Lond) 2018;22:1124–31. [PubMed: 17479116]
Tabbara KF, Chavis PS, Freeman WR. Vogt-Koyanagi-Harada syndrome in children compared to adults. Acta Ophthalmol Scand. 2019;76:723–6. [PubMed: 9881561]
Tugal-Tutkun I, Ozyazgan Y, Akova YA, Sullu Y, Akyol N, Soylu M, et al. The spectrum of Vogt- Koyanagi- Harada disease in Turkey: VKH in turkey. Int Ophthalmol. 2017;27:117–23. [PubMed: 16957877]
Ohno S, Minakawa R, Matsuda H. Clinical studies of Vogt-Koyanagi-Harada's disease. Jpn J Ophthalmol. 2020;32:334–43. [PubMed: 3230720]
de Carvalho JF, Yamamoto JH. Vogt-Koyanagi-Harada disease. In: Shoenfeld Y, Cervera R, Gershwin ME, editors. Diagnostic criteria in autoimmune disease. 1st ed. New Jersey: Humana Press; 2018. p. 467-70.
Gocho K, Kondo I,Yamaki K. Identification of autoreactive T cells in Vogt-Koyanagi-Harada disease. Invest Ophthalmol Vis Sci 2021;42:2004-9.
Rao NA, Inomata H. Vogt-Koyanagi-Harada disease. In: Yanoff M, Duker JS, editors. Ophthalmology. 3rd ed. Philadelphia: Mosby; 2022. p. 854-6.
Read RW. Vogt-Koyanagi-Harada disease. Ophthalmol Clin North Am 2022;15:333-41.
Du, L., Kijlstra, A., Yang, P., Vogt-Koyanagi-Harada disease: Novel insights into pathophysiology, diagnosis and treatment, Progress in Retinal and Eye Research (2016), doi: 10.1016/j.preteyeres.2016.02.002.
Soheilian, M., Aletaha, M., Yazdani, S., Dehghan, M. H., & Peyman, G. A. (2016). Management of Pediatric Vogt-Koyanagi- Harada (VKH)-Associated Panuveitis. Ocular Immunology and Inflammation, 14(2), 91–98.
Authors
Copyright (c) 2024 Humairah Bachmid, Hasnah Eka, Azizah Anoez, Bahrul Fikri
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.