Two cases of Vogt–Koyanagi–Harada’s disease in sub-Saharan Africa

Tunji S Oluleye,1 Adekunle O Rotimi-Samuel,2 Adetunji Adenekan,2 Olubanke T Ilo,2 Folashade B Akinsola,2 Adeola O Onakoya,2 Olufisayo T Aribaba,2 Adebukunola Adefule-Ositelu,2 Kareem O Musa,2 Yele Oyefeso2 1Retina and Vitreous Unit, Department of Ophthalmology, University College Hospital, Ibadan, 2Department of Ophthalmology, Guinness Eye Center, Lagos University Teaching Hospital, Lagos, Nigeria Abstract: Vogt–Koyanagi–Harada’s (VKH) disease has been reported to be rare in sub-Saharan Africa. Two Nigerians with the disease are presented in this report. The first patient, a 32-year-old pregnant Nigerian woman presented with a 1-month history of bilateral blurring of vision, persistent headache, and alopecia. Presenting visual acuity was 1 m counting fingers in both eyes. Examination revealed vitiligo and poliosis with bilateral panuveitis as well as bilateral exudative retinal detachment. A clinical assessment of complete VKH disease was made. The patient commenced systemic and topical steroids that resulted in remarkable recovery of vision and control of inflammation. The second patient, a 56-year-old Nigerian woman presented with severe headache, tinnitus, and visual loss in both eyes of 2 weeks duration. There was associated redness of both eyes and photophobia. Examination showed visual acuity of Hand motion (HM) and counting fingers at 1 meter (CF). in the right and left eye, respectively, with bilateral panuveitis and bilateral exudative retinal detachment. Subsequent follow-up showed poliosis, vitiligo, and sunsetting fundus appearance. The patient improved with systemic and topical corticosteroids. Developing a high index of suspicion is necessary in diagnosing VKH disease, even in sub-Saharan Africa. Prompt institution of appropriate treatment prevents blindness. Keywords: Vogt–Koyanagi–Harada’s disease, exudative retinal detachment, vitiligo, ­sub-Saharan Afric