To present a case of Vogt-Koyanagi-Harada (VKH) associated with type I diabetes mellitus and celiac disease in a 3 year old female.
Methods
We studied a three-year old female who presented with clinical manifestation of VKH and type I Diabetes mellitus and ciliac disease.
Results
Patient was found to have hyperglycemia with type I diabetes mellitus. Duodenal mucosal biopsy specimen confirmed the diagnosis of celiac disease. Patient's ocular inflammation was treated by topical and systemic corticosteroid and immune-suppressive therapy. Her diabetes mellitus was controlled by insulin and her celiac disease was controlled by gluten-free diet.
Conclusions
The association of VKH with two autoimmune diseases (celiac disease and type I diabetes mellitus) is rare. This case is, to our knowledge, the youngest patient reported with VKH.
ReadR.W., HollandG.N., RaoN.A.Perspective: Revised Diagnostic Criteria for Vogt-Koyanagi-Harada Disease: Report of an International Committee On Nomenclature.Am J Ophthalmol2001; 131: 647–52.
2.
FedermanD.G., KravetzJ.D., RuserC.B.Vogt-Koyanagi-Harada syndrome and ulcerative colitis.South Med J2004; 97: 169–71.
IslamS.M., TabbaraK.F.Causes of uveitis at The Eye Center in Saudi Arabia: a retrospective review.Ophthalmic Epidemiol2002; 9: 239–49.
8.
YamakiK., GochoK., HayakawaK., KondoI., SakuragiS.Tyrosinase family proteins are antigens specific to Vogt-Koyanagi-Harada disease.J Immunol2000; 165: 7323–9.
9.
YamakiK., KondoI., NakamuraH., MiyanoM., KonnoS., SakuragiS.Ocular and extraocular inflammation induced by immunization of tyrosinase related protein 1 and 2 in Lewis rats.Exp Eye Res2000; 71: 3619.
10.
KobayashiH., KokuboT., TakahashiM.Tyrosinase epitope recognized by an HLA-DR-restricted T-cell line from a Vogt-Koyanagi-Harada disease patient.Immunogenetics1998; 47: 398–403.
11.
RathinamS.R., NamperumalsamyP., NozikR.A., CunninghamE.T.Jr.Vogt-Koyanagi-Harada syndrome after cutaneous injury.Ophthalmology1999; 106: 635–8.
12.
YangP., JiL., ZhouH.A. Disturbed expression of Fas/FasL on CD4(+) and CD8(+)T cells in Behçet's disease, Vogt- Koyanagi-Harada syndrome, and idiopathic anterior uveitis.Ocul Immunol Inflamm2001; 9: 185–91.
13.
YangP., ChenL., ZhouH.Resistance of lymphocytes to Fas-mediated apoptosis in Behçet's disease and Vogt-Koyanagi-Harada syndrome.Ocul Immunol Inflamm2002; 10: 47–52.
14.
WeiszJ.M., HollandG.N., RoerL.N.Association between Vogt-Koyanagi-Harada syndrome and HLA-DR1 and DR4 in Hispanic patients in living in southern California.Ophthalmology1995; 102: 1012–5.
15.
Arellanes-GarciaL., BautistaN., MoraP., Ortega-LarroceaG., BurguetA., GorodezkyC.HLA-DR is strongly associated with Vogt-Koyanagi-Harada disease in Mexican Mestizo patients.Ocul Immunol Inflamm1998; 6: 93–100.
16.
GoldbergA.C., YamamotoJ.H., ChiarellaJ.M.HLA-DRB1 *0405 is predominant allele in Brazilian patients with Vogt-Koyanagi-Harada disease.Hum Immunol1998; 59: 183–8.
17.
ShindoY., OhnoS., YamamotoT., NakamuraS., InokoH.Complete association of the HLA-DRB1 *04 and DQB1 *04 alleles with Vogt-Koyanagi-Harada's disease.Hum Immunol1994; 39: 169–76.
18.
ShindoY., InokoH., YamamotoT., OhnoS.HLA-DRB1 typing of Vogt-Koyanagi-Harada's disease by PCR-RFLP association with DRB1 *0405 and DRB1 *0410.Br J Ophthalmol1994; 78: 223–6.
19.
NomuraS., MatsuzakiT., OzakiY.Clinical significance of HLA-DRB1 *0410 in Japanese patients with idiopathic thrombocytopenic purpura.Blood1998; 91: 3616–22.
20.
YawataN., NakamuraS., KijimaM.High incidence of glucose intolerance in Vogt-Koyanagi-Harada disease.Br J Ophthalmol1999; 83: 39–42.
21.
RewersM., LiuE., SimmonsJ., RedondoM.J., HoffenbergE.J.Celiac disease associated with type 1 diabetes mellitus.Endocrinol Metab Clin North Am2004; 33: 197–214.
22.
SabbatellaL., Di TolaM., PicarelliA.The high frequency of coeliac disease and other autoimmune diseases in subjects affected by Type I (insulin-dependent) diabetes mellitus and in their first-degree relatives.Diabetologia2002; 45: 748.
23.
WinnockF., Van AutreveJ., GorusF.K., Belgian Diabetes Registry. Beta-cell thyroid, gastric, adrenal and coeliac autoimmunity and HLA-DQ types in type diabetes.Clin Exp Immunol2001; 126: 236–41.
24.
GillettP.M., GillettH.R., IsraelD.M.High prevalence of celiac disease in patients with type 1 diabetes detected by antibodies t endomysium and tissue trans glutaminase.Can J Gastroenterol2001; 15: 297–301.
25.
CollinP., HakanenM., SalmiJ., MakiM., KaukinenK.Autoimmune hypopituitarism in patients with coeliac disease: symptoms confusingly similar.Scand J Gastroenterol2001; 36: 558–60.
26.
Galli-TsinopoulouA., Nousia-ArvanitakisS., DracoulacosD., XefteriM., KaramouzisM.Autoantibodies predicting diabetes mellitus type I in celiac disease.Horm Res1999; 52: 119–24.
27.
MaruyamaY, HayashiH., TakahashiK., IinoK., KoraY.A case of insulin dependent diabetes mellitus following systemic treatment for Vogt-Koyanagi-Harada syndrome.Ophthalmic Surg Lasers2000; 31: 487–90.
28.
EgashiraK., YamamotoT., TsujiS., OhnishiA., MuraiY.A case of myasthenia gravis complicated with chronic rheumatoid arthritis with Vogt-Koyanagi-Harada disease.Rinsho Shinkeigaku1987; 27: 859–61.
