Case Presentation:
This is a case that has been reported previously in 2017 by me and
published in CPSP journal.5 A 25 year old female
presented with the history of prodromal symptoms of headache and neck
stiffness. On examination there was bilateral optic disc hyperemia and
swelling mimicking the picture of optic neuritis. The patient later
developed bilateral pan uveitis with SRD. The case was treated
successfully with posterior subtenon injection (PSTI) of triamcinolone.
Later on in this patient an unusual finding developed which I am going
to report for the first time. She came with the complaint of hair growth
on radial and palmer surface of distal phalanx of thumb after two years
in October 2019. Some of the hairs were near mucocutaneous junction.
These hairs were fine, thin like vellus hairs. (Fig. No.1) Dermatologist
was consulted for these integumentary changes. There was no history of
hirsutism. This unique finding of vellus hairs came as a surprise as on
extensive search of literature no such finding has been reported as yet
in VKHD. She also developed tinnitus along with development of vellus
hairs. The patient was on low dose steroids, prednisolone 5mg /day. The
auditory symptoms were relieved by increasing the dose to 10mg per day.
Whenever we stopped steroids the auditory symptoms recur and so the
patient was kept on 5mg prednisolone per day for further two years. She
didn’t develop glaucoma or cataract during treatment.
She again developed hair in June 2021 and came twice to show these hairs
(Fig.No. 2). These were very fine short hair. The hair remained for 4-6
weeks. After that she never complained of hair growth again.
Differential diagnosis :
Physicians must consider differential diagnosis of Vogt-Koynagi-Harada
Disease in patients presenting with atypical signs and symptoms to make
an early and accurate diagnosis before treating the ailment carefully.
Sacrcoidos and alopecia areata are some immune mediated disease that
must be considered as differential diagnosis. Endocrine and metabolic
causes like hypothyroidism and Cushing’s syndrome, along with
medication-induced or post-inflammatory hypertrichosis, should also be
considered. Additionally, genetic conditions like piebaldism and
neoplastic syndromes such as Langerhans cell histiocytosis may present
with similar findings.