Vogt-Koyanagi-Harada disease associated with brainstem encephalitis

Area of Science:

• Neuro-ophthalmology
• Neurology
• Immunology

Background:

• Vogt-Koyanagi-Harada (VKH) disease is a multisystem inflammatory disorder typically affecting the eyes and central nervous system.
• Neurological manifestations beyond typical meningoencephalitis in VKH are less commonly reported.
• This case highlights a rare presentation of VKH involving the brainstem.

Purpose of the Study:

• To report a case of Vogt-Koyanagi-Harada disease presenting with brainstem encephalitis.
• To describe the clinical and radiological findings associated with this rare manifestation.
• To evaluate the treatment response to corticosteroids.

Main Methods:

• Case report of a 28-year-old male with a 2-year history of VKH.
• Clinical assessment including neurological examination.
• Magnetic Resonance Imaging (MRI) of the brain to identify inflammatory lesions.
• Monitoring of treatment response to corticosteroid therapy.

Main Results:

• The patient developed one-and-a-half syndrome, right-sided facial hypoesthesia, facial nerve palsy, hearing loss, and limb ataxia.
• MRI revealed inflammatory lesions in the pons extending to the left middle cerebellar peduncle.
• Corticosteroid treatment resulted in significant improvement of neurological symptoms and resolution of MRI lesions.

Conclusions:

• This case suggests a possible association between Vogt-Koyanagi-Harada disease and brainstem encephalitis.
• VKH should be considered in the differential diagnosis of brainstem lesions presenting with neurological deficits.
• Prompt corticosteroid treatment can effectively manage neurological complications of VKH.