Vogt-Koyanagi-Harada disease occurring during pegylated interferon-α2b and ribavirin combination therapy for chronic hepatitis C

Abstract

Vogt-Koyanagi-Harada (VKH) disease is a multisystem syndrome characterized by ocular (uveitis and retinal detachment), neurological (headache, tinnitus, and meningitis), and integumentary (vitiligo, alopecia, and poliosis) involvement. Although the pathogenesis of VKH disease is not well understood, an autoimmune T-cell response to a melanocyte-associated antigen is considered to be a cause of VKH disease. The complex immunological response to interferon and ribavirin may induce or exacerbate the autoimmune condition; however, VKH disease is a very rare complication associated with interferon therapy in chronic hepatitis C. We report a case of VKH disease occurring during pegylated interferon-α2b and ribavirin combination therapy for chronic hepatitis C.

Figure 1

The patient's face before treatment (A). The 5-cm vitiligo on the forehead appears after 9 months of pegylated interferon-α2b and ribavirin combination therapy (B).

Figure 2

Retinal fluorescein angiography reveals characteristic multiple pinpoint leakages of fluorescein from the choroid into the subretinal space on the right eye (A) and the left eye (B).

Figure 3

Optimal coherence tomography of the right eye shows serous retinal detachments (arrows) with subretinal septa (A). The retinal detachment improved at 2 weeks after the steroid therapy (B).