Clinical features, diagnosis, and management of COVID-19 vaccine-associated Vogt-Koyanagi-Harada disease

Abstract

Vogt-Koyanagi-Harada (VKH) disease is a rare and serious ocular adverse reaction following COVID-19 vaccination. This study aimed to evaluate the clinical features, diagnosis and management of COVID-19 vaccine-associated VKH disease. Case reports of VKH disease after COVID-19 vaccination were collected up to February 11, 2023 for retrospective analysis. Twenty-one patients (9 males and 12 females) were included, with a median age of 45 years (range 19–78), from three main regions, Asia (12/21), the Mediterranean region (4/21), and South America (5/21). Fourteen patients developed symptoms after the first dose of the vaccine, and 8 after the second dose. Vaccines included mRNA vaccine (10 cases), virus vector vaccine (6 cases), and inactivated vaccine (5 cases). The average time interval from vaccination to onset of symptoms was 7.5 days (range 12 hours to 4 weeks). All 21 patients experienced visual impairment after vaccination, with 20 cases involving both eyes. Sixteen patients showed symptoms of meningitis. Serous retinal detachment was observed in 16 patients, choroidal thickening was observed in 14, aqueous cell in 9, and subretinal fluid in 6. CSF pleocytosis was detected in 7 patients and skin symptoms were found in 3 patients. All patients received corticosteroid therapy, and 8 also received immunosuppressive agents. All patients recovered well, with a mean recovery time of 2 months. Early diagnosis and early treatment are crucial to the prognosis of patients with VKH after vaccination with COVID-19 vaccine. The risk of vaccination against COVID-19 in patients with a history of VKH disease should be evaluated clinically.

Vogt-Koyanagi-Harada Syndrome Following COVID-19 mRNA Vaccination: Th2 to Th1 Transition-related Molecular Machinery

“…It has been shown previously that COVID-19 vaccine-associated VKH syndrome usually shows similar ophthalmological course as idiopathic VKH syndrome ( 2 ); however, it is unclear regarding the dermatological features in COVID-19 vaccine-associated VKH syndrome. In the current case, vitiligo developed 9 months after the first ophthalmological symptoms, compared with dermatological findings of idiopathic VKH syndrome, which usually appear approximately 3–4 months after onset.…”

“…There have been > 20 case reports of COVID-19 vaccine-associated VKH syndrome since 2021 ( 2 ). Probably because they were diagnosed by the ophthalmological approach, no report described details of dermatological symptoms, except for 1 case of VKH syndrome with poliosis diagnosed only by the ophthalmological approach ( 4 ).…”

“…Vogt-Koyanagi-Harada (VKH) syndrome is a multisystem disorder presenting with ophthalmological, neurological, and dermatological symptoms ( 1 ). There are > 20 case reports of SARS-CoV-2 (COVID-19) vaccine-associated VKH syndrome ( 2 ). However, no report has described details of dermatological features.…”

Kounis syndrome following COVID-19 vaccination: Clinical manifestations, mechanisms and management

“…This study analyzed pooled case reports of Kounis syndrome after COVID-19 vaccination to better evaluate its clinical manifestations and medical examination features and to improve the ability of clinicians to recognize this rare syndrome in the early stage. 17 …”