Vogt-Koyanagi-Harada Disease Associated with Hepatitis B Vaccination

Area of Science:

• Ophthalmology
• Immunology
• Vaccinology

Background:

• Vogt-Koyanagi-Harada (VKH) disease is a rare, idiopathic systemic inflammatory disorder affecting melanin-rich tissues.
• The etiology of VKH disease is unknown but is hypothesized to involve a viral prodrome in genetically susceptible individuals.
• VKH disease primarily impacts the uveoscleral tissues, including the choroid, retinal pigment epithelium, and outer retina.

Observation:

• A 43-year-old male developed acute visual disturbances, including blurry vision, photophobia, and ocular redness, three days after receiving the hepatitis B vaccine.
• Clinical examination revealed characteristic signs of VKH disease: multifocal placoid lesions, choroidal thickening, and serous macular detachment.
• Systemic symptoms of hearing loss, tinnitus, and integumentary changes were also reported, consistent with a diagnosis of VKH disease.

Findings:

• Laboratory investigations for infectious and autoimmune markers were negative, ruling out common causes.
• Treatment with oral corticosteroids led to symptom resolution and significant visual recovery.
• Long-term management involved methotrexate for sustained control of the inflammatory process.

Implications:

• This case suggests a potential association between hepatitis B vaccination and the onset of Vogt-Koyanagi-Harada disease.
• Further research is warranted to investigate the immunologic mechanisms linking hepatitis B vaccination to VKH disease.
• Clinicians should consider vaccination history in the differential diagnosis of patients presenting with symptoms suggestive of VKH disease.