Authors:

Salem Bouomrani1,2, Wided Letaïef2,3, Warda Mahdhaoui1,2, Amin Hammami1,2, Khawla Souid1,4, Ali Naffati1,2

1Department of Internal Medicine, Military Hospital of Gabes, Gabes 6000, Tunisia,

2Department of Internal Medicine, Sfax Faculty of Medicine, University of Sfax, Sfax 3029, Tunisia,

3Department of Obstetrics and Gynecology, Regional Hospital of Gabes, Gabes 6000, Tunisia,

4Dermatology Consultant, Department of InternalMedicine, Derma-Sud Center, Mongi Slim Street, Gabes 6000, Tunisia

Source:

Clinical Research in Dermatology

ABSTRACT

Lumbar localization of vitiligo is rare and that of the sacral region is exceptional. Vogt-Koyanagi-Harada (VKH) disease also remains an unusual etiology of vitiligo (1.4% of cases). Vitiligo may rarely be the first clinical sign of this disease. We report the original observation of lumbosacral vitiligo revealing VKH disease in a 66-year-old Tunisian woman. Early diagnosis
and appropriate management are necessary since the vitiligo associated with VKH disease can be reversible under treatment.

Key words:

Lumbosacral region, vitiligo, Vogt-Koyanagi-Harada disease.

Vogt-Koyanagi-Harada disease (VKH) is an autoimmune disease characterized by the association of recurrent posterior uveitis with polymorphic extraocular involvement: Meningeal, auditory, and skin. Vitiligo, especially from the lumbosacral region, is an
exceptional but very suggestive sign of the disease. We are reporting a case.

A 66-year-old Tunisian woman, type 2 diabetic and hypertensive, was referred by her ophthalmologist for exploration of recurrent bilateral posterior uveitis. The interrogation found the notion of dizziness and a significant decrease in hearing. The ophthalmological examination showed bilateral non-granulomatous posterior uveitis, reflex pyramidal syndrome, alopecia areata, poliosis of the eyelashes and eyebrows, and vitiligo of the lumbosacral region [Figures 1 and 2].

Biology showed a moderate biological inflammatory syndrome and lymphopenia at 1100/mm3. Analysis of the cerebrospinal fluid showed aseptic lymphocytic meningitis. The
cerebromedullary magnetic resonance imaging was without abnormalities. Immunological, hormonal, and infectious tests were negative. The diagnosis of VKH was thus retained and
the patient was treated with systemic corticosteroids (3 boli of methylprednisolone for 3 days relayed by 1 mg/kg/d of prednisone). The evolution was favorable with an improvement  in his visual acuity, his hearing, his neurological examination, and normalization of the parameters of the cerebrospinal fluid after 1 month of the treatment.

Lumbar localization of vitiligo is rare: 3.8% in the Japanese series of 144 cases of Tanioka et al. and that of the sacral region remains exceptional.[1] VKH disease also remains an unusual etiology of vitiligo: 1.4% of cases.[1] Vitiligo may rarely be the first clinical sign of this disease.[2] Early diagnosis and appropriate management are necessary since the vitiligo associated with VKH disease can be reversible under treatment.[3,4]

Address for correspondence:

Dr. Salem Bouomrani, Department of Internal Medicine, Military Hospital of Gabes, Gabes 6000, Tunisia.
E-mail: salembouomrani@yahoo.fr

© 2019 The Author(s). This open access article is distributed under a Creative Commons Attribution (CC-BY) 4.0 license.

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