Papasavvas Ioannis, Herbort Carl P
Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Teaching Centre Clinic Montchoisi, Lausanne, Switzerland.
J Ophthalmic Inflamm Infect. 2021 Jul 5;11(1):21. doi: 10.1186/s12348-021-00251-5.
BACKGROUND/PURPOSE: Vogt-Koyanagi-Harada (VKH) disease is a primary stromal choroiditis with bilateral granulomatous panuveitis. If initial-onset VKH is treated early and relentlessly the disease can be controlled and even "cured" in a substantial number of cases. We are reporting on a patient treated early and in a sustained fashion who was inflammation free for seven years but who presented a reactivation 6 weeks after the second dose of anti-SARS-CoV-2 vaccination.
A 43-year-old woman presented with severe initial-onset VKH disease which was brought under control using steroidal and non-steroidal Immunosuppression (mycophenolic acid and cyclosporine) with additional infliximab infusions because of the persistence of subclinical choroiditis identified on ICGA. Under infliximab alone disease had been inflammation free with no subclinical disease and absence of sunset glow fundus for 6 years. However, following anti-SARS-CoV-2 vaccination, severe resurgence of the disease occurred with exudative retinal detachments. Disease was rapidly brought again under control with oral prednisone (1 mg/kg) therapy and a new loading scheme of infliximab therapy.
VKH disease results from an autoimmune process directed against melanocyte associated antigens which can be controlled when early and sustained immunosuppressive treatment is introduced. It seems that anti-SARS-CoV-2 vaccination can be at the origin of reactivation of long-time controlled disease.
背景/目的：伏格特-小柳-原田（VKH）病是一种伴有双侧肉芽肿性全葡萄膜炎的原发性基质性脉络膜炎。如果初发性VKH病能早期且积极地治疗，在相当多的病例中疾病可以得到控制甚至“治愈”。我们报告一例早期且持续接受治疗的患者，该患者七年无炎症，但在接种第二剂抗SARS-CoV-2疫苗后6周病情复发。
一名43岁女性患有严重的初发性VKH病，通过使用类固醇和非类固醇免疫抑制药物（霉酚酸和环孢素）以及因吲哚菁绿血管造影（ICGA）发现的亚临床脉络膜炎持续存在而额外输注英夫利昔单抗，病情得到控制。仅使用英夫利昔单抗治疗期间，疾病无炎症，无亚临床疾病，眼底无晚霞样改变，持续6年。然而，在接种抗SARS-CoV-2疫苗后，疾病严重复发并伴有渗出性视网膜脱离。通过口服泼尼松（1mg/kg）治疗和新的英夫利昔单抗治疗负荷方案，疾病迅速再次得到控制。
VKH病是由针对黑素细胞相关抗原的自身免疫过程引起的，早期且持续的免疫抑制治疗可以控制该病。看来抗SARS-CoV-2疫苗接种可能是长期控制的疾病复发的原因。
