Delayed diagnosis of myelitis in a patient with Vogt-Koyanagi-Harada disease: a case report

Abstract

A case of myelitis following Vogt-Koyanagi-Harada (VKH) disease is reported, in which diagnosis and treatment were delayed. A 43-year-old male patient diagnosed with VKH disease presented at the Spine Centre of Yeungnam University Hospital, Daegu, Republic of Korea, with motor weakness, sensory deficit in both lower extremities, and dysuria for the previous 3 months. VKH disease had been diagnosed 15 months previously, based on vision loss in both eyes and the presence of bilateral nontraumatic granulomatous iridocyclitis, exudates, and retinal oedema. The patient exhibited severe motor weakness (right lower extremity, Medical Research Council (MRC) muscle scale, grade 2–0; left lower extremity, MRC grade 0). On cervical magnetic resonance imaging, a high-intensity T2 signal was observed in the spinal cord C4–C7 segments. Cerebrospinal fluid analysis revealed slightly elevated white blood cell counts. The patient was diagnosed with myelitis complicating VKH disease. Intravenous and oral corticosteroid therapy was administered. After steroid treatment, the patient’s motor function in the right lower extremity was significantly improved (MRC grade 4–3). However, the left lower extremity did not show any improvement (MRC grade 0). To achieve a good treatment outcome, the diagnosis and treatment of myelitis in VKH disease should not be delayed.