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Published on: December 17, 2021
Vogt-Koyanagi-Harada disease presenting secondary to a post-infectious Mycoplasma pneumoniae autoimmune response
Christian I Wade1, Keith E Earley2, Grant A Justin3,4
1School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Purpose:
To report a rare case of Vogt-Koyanagi-Harada disease likely secondary to post-infectious Mycoplasma pneumoniae autoimmune response in a 14-year-old Hispanic female.
Observations:
On presentation, visual acuity was 20/400 in the right eye and 20/20 in the left eye. The patient also had bilateral hyperemia, subretinal fluid, and vitreous cell graded at 1+. Fluorescein angiography and indocyanine green chorioangiography showed bilateral peripapillary hypofluorescence consistent with blocking and hyperflourescence consistent with staining. Laboratory testing showed elevated M. pneumoniae IgM and rising IgG antibodies. Topical steroids and oral steroids helped mitigate the systemic disease process and fully restore visual acuity through the 7-week mark.
Conclusions And Importance:
The patient had elevated M. pneumoniae IgM and rising IgG antibodies resulting in ocular inflammation likely secondary to an autoimmune response. In this case of post-infectious M. pneumoniae, topical corticosteroids were beneficial in mitigating ocular manifestations initially, although oral steroids were needed and tapered over 6 weeks.
Insights
A rare case of Vogt-Koyanagi-Harada disease was linked to Mycoplasma pneumoniae infection. Prompt steroid treatment restored vision in a young patient, highlighting the autoimmune connection.
Area of Science:
- Ophthalmology
- Infectious Disease
- Immunology
Background:
- Vogt-Koyanagi-Harada (VKH) disease is a rare, idiopathic multisystem inflammatory disorder.
- Ocular manifestations of VKH disease can lead to significant visual impairment.
Observation:
- A 14-year-old Hispanic female presented with decreased visual acuity, bilateral hyperemia, subretinal fluid, and vitreous cells.
- Diagnostic imaging revealed characteristic findings of VKH disease.
- Laboratory tests indicated elevated Mycoplasma pneumoniae IgM and rising IgG antibodies.
Findings:
- The patient's clinical presentation and serological results strongly suggested a diagnosis of VKH disease secondary to Mycoplasma pneumoniae infection.
- Ocular inflammation, including decreased visual acuity, was effectively managed with topical and oral corticosteroids.
Implications:
- This case highlights a potential autoimmune response to Mycoplasma pneumoniae triggering VKH disease.
- Early diagnosis and appropriate corticosteroid therapy are crucial for managing ocular manifestations and preserving vision.
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