[Vogt Koyanagi Harada syndrome in children: diagnosis and management]

Uveitis accounts for 5% to 10% of all cases of uveitis in children. Vogt-Koyanagi-Harada syndrome affects children very unfrequently. We report a case of a 14-year-old girl who presented with a bilateral uveitis with posterior predominance associated with an important serous retinal detachment and signs of meningeal irritation. No specific cause could be identified. The initial treatment consisted in administration of high dose steroids given in i.v. bolus at the dose of 10 mg/Kg/day then in oral steroids at the dose of 1 mg/Kg/day with slow tapering during 1 year. The evolution was marked by an excellent recuperation of the visual acuity, a total disappearance of the serous retinal detachment, the development of choroidal depigmentation and the occurrence of poliosis. This evolution was in favour of a Vogt-Koyanagi-Harada syndrome. The diagnosis of this syndrome is usually difficult to establish at its onset. Most often the evolution allows to correct and confirm the diagnosis. Megadoses of corticosteroid therapy and cytotoxic agents may be necessary. The visual prognosis may be poor in severe cases.