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.