A case report of vogt-koyanagi-harada disease with generalized vitiligo

An 80-year-old man presented with poliosis that developed suddenly after having surgery for macular degeneration of his right eye about 10 years ago. Vitiligo on his face followed the poliosis, and it gradually spread over most of his body surface during the subsequent years. He had received some phototherapy treatments in another hospital before but these were not successful. He visited the ophthalmology department of our hospital for bilateral uveitis, which occurred with sudden nephelopsia 3 weeks before his visit. Some postinflammatory changes in the anterior region of the eye and a characteristic "sunset-glow"fundus were observed. We carried out a skin biopsy from the vitiligo on his left lower eyelid. In a histological analysis, no melanocytes were observed in the basal layer of the epidermis, and Melan-A was negative in his epidermis. We diagnosed recurrent Vogt-Koyanagi-Harada disease (VKH) ; however, systemic corticosteroid therapy was not carried out, because there were no signs of acute inflammation such as meningism, dysacousis, or retinal detachment. Furthermore, instillation improved the ocular symptoms. Steroid ointment was unsuccessful against the vitiligo. In VKH, some signs of depigmentation such as a"sunset-glow"fundus and vitiligo appear 2-3 months after uveitis, and bilateral vitiligo is often distributed over the eyelid, face, and neck. Although there have been several case reports of VKH with extensive vitiligo, the generalized vitiligo observed in the present case is very rare.