Early resolution of subretinal fluid without high-dose corticosteroids in a pregnant patient with Vogt-Koyanagi-Harada disease: a case report

Abstract

BackgroundAt present, there is no standard of treatment using systemic high-dose corticosteroids in cases of pregnant women with Vogt-Koyanagi-Harada (VKH) disease. Although high-dose systemic corticosteroid treatment is often used for VKH disease during pregnancy, it also poses a risk to the fetus.FindingsA 29-year-old woman in the 34th week of pregnancy experienced bilateral metamorphopsia. She had been receiving 5 mg of prednisolone daily for the past 8 years as treatment for rheumatoid arthritis. In order to prevent progression of bilateral serous retinal detachment caused by VKH disease, we recommended the use of high-dose systemic corticosteroids but the patient refused. Thus, we administered only topical ophthalmic betamethasone for mild anterior uveitis. Surprisingly, however, the bilateral bullous retinal detachment healed in just 19 days after the onset of symptoms. A healthy baby was born 1 month later, and sunset glow fundus was subsequently observed without any recurrence of uveitis.ConclusionsWe report a case in which bilateral subretinal fluid caused by VKH disease in a young woman during late pregnancy resolved without high-dose corticosteroid treatment. Pregnancy may have had a beneficial effect on uveitis activity caused by VKH disease. To our knowledge, this report describes the shortest healing period for bilateral bullous retinal detachment in a pregnant woman with VKH disease.

Reply to “Early resolution of subretinal fluid without high-dose corticosteroids in a pregnant patient with Vogt-Koyanagi Harada disease” by Sugita et al.

“…What is interesting is the occurrence of inflammation in the second trimester of pregnancy and the rapid resolution of fluid within 2 weeks without treatment, in a patient without a prior history of VKH. However, unlike the case by Sugita et al [ 1 ], our patient did not have any systemic disease and did not receive any corticosteroids in the past. Though it is difficult to explain the observation seen, this case in addition to the case reported by Sugita et al [ 1 ] has shown early resolution of subretinal fluid without treatment in VKH leading us to revisit the role of pregnancy in VKH.…”

“…However, unlike the case by Sugita et al [ 1 ], our patient did not have any systemic disease and did not receive any corticosteroids in the past. Though it is difficult to explain the observation seen, this case in addition to the case reported by Sugita et al [ 1 ] has shown early resolution of subretinal fluid without treatment in VKH leading us to revisit the role of pregnancy in VKH.

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“…We read with great interest the brief report by Sugita et al [ 1 ] regarding “Early resolution of subretinal fluid without high-dose corticosteroids in a pregnant patient with Vogt-Koyanagi-Harada disease.” We would like to share a similar case who presented to our clinic recently. A 31-year-old woman in the second trimester of pregnancy (24 weeks) presented with sudden blurring of vision in both eyes of 2 days duration.…”

Azathioprine During the First Trimester of Pregnancy in a Patient with Vogt-Koyanagi-Harada Disease: A Multimodal Imaging Follow-Up Study

“…Studies using Swept Source Optical Coherence Tomography have demonstrated anatomical choroidal remodeling and consistent retinal changes after the use of systemic corticosteroid therapy [ 7 ]. In some cases, observation is the preferred option due to the mothers’ refusal of treatment [ 8 ].…”

Vogt‐Koyanagi‐Harada disease in pregnancy: Case report and review of 32 patients in the literature

“…Vogt‐Koyanagi‐Harada disease may occur in pregnancy and pose a problem how to apply the standard of care in a pregnant woman 12–14 . In this report, we described a patient who developed Vogt‐Koyanagi‐Harada disease in pregnancy and also summarized 32 patients with the disease in pregnancy in the literature to elucidate the outcome of treatment 15–44 …”