Neurol Case Rep | Volume 3, Issue 1 | Case Report | Open Access

Multiple Sclerosis in a Patient with Vogt-Koyanagi-Harada Syndrome: A Rare Association and a Treatment Challenge

Anguizola Tamayo David Alberto^1*, Sanchez Menoyo Jose Luis¹, Artaraz Beobide Joseba Inaki², Vidorreta Ballesteros Lucia¹, Vicente Olabarria Inigo³, Gomez-Beldarrain Marian¹ and Garcia-Monco Juan Carlos⁴

¹Department of Neurology, Hospital Galdakao-Usansolo, Spain ²Department of Ophthalmology, Hospital Universitario Cruces, Spain ³Osatek MRI Unit, Hospital de Galdakao-Usansolo, Spain ⁴Department of Neurology, Hospital Universitario Basurto, Spain

^*Correspondance to: Anguizola Tamayo David Alberto 

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Abstract

The Vogt-Koyanagi-Harada Syndrome (VKHS) is characterized by meningitis, uveitis, and skin lesions. Its association to Multiple Sclerosis (MS) is extremely rare but may condition MS therapy. A 35-year-old female presented with blurred vision, speech difficulties and left-hand clumsiness with multiple brain and spinal cord white matter lesions and oligoclonal banding in the cerebrospinal fluid, consistent with Multiple Sclerosis (MS). She had been previously diagnosed with VKHS on the presence of bilateral granulomatous panuveitis and vitiligo. Her neurological picture was not consistent with the CNS complications that occasionally accompany the VKHS, and thus we concluded that she had a dual pathology. She was initially treated with boluses of methyl prednisolone and, 4 months after admission azathioprine was added considering both conditions with a favourable outcome. This combination is extremely rare and poses a particularly difficult challenge in management, since the immunomodulatory drugs for MS can worsen concomitant autoimmune disorders and therefore may be inappropriate for VKHS. Older drugs like azathioprine may be indicated in this combination of disorders and worked favorably in this patient.

Keywords:

Vogt-Koyanagi-Harada syndrome; Multiple sclerosis; Azathioprine; Uveitis

Citation:

Alberto ATD, Luis SMJ, Inaki ABJ, Lucia VB, Inigo VO, Marian G-B, et al. Multiple Sclerosis in a Patient with Vogt- Koyanagi-Harada Syndrome: A Rare Association and a Treatment Challenge. Neurol Case Rep. 2020;3(1):1017..