scholarly journals Reactivation of Vogt-Koyanagi-Harada disease under control for more than 6 years, following anti-SARS-CoV-2 vaccination

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ioannis Papasavvas ◽  
Carl P. Herbort
Keyword(s):  
Oral Prednisone ◽  
Immunosuppressive Treatment ◽  
Autoimmune Process ◽  
Subclinical Disease ◽  
Initial Onset ◽  
Long Time ◽  
Sunset Glow Fundus ◽  
Stromal Choroiditis ◽  
Vkh Disease ◽  
Loading Scheme

Abstract Background/purpose Vogt-Koyanagi-Harada (VKH) disease is a primary stromal choroiditis with bilateral granulomatous panuveitis. If initial-onset VKH is treated early and relentlessly the disease can be controlled and even “cured” in a substantial number of cases. We are reporting on a patient treated early and in a sustained fashion who was inflammation free for seven years but who presented a reactivation 6 weeks after the second dose of anti-SARS-CoV-2 vaccination. Case report A 43-year-old woman presented with severe initial-onset VKH disease which was brought under control using steroidal and non-steroidal Immunosuppression (mycophenolic acid and cyclosporine) with additional infliximab infusions because of the persistence of subclinical choroiditis identified on ICGA. Under infliximab alone disease had been inflammation free with no subclinical disease and absence of sunset glow fundus for 6 years. However, following anti-SARS-CoV-2 vaccination, severe resurgence of the disease occurred with exudative retinal detachments. Disease was rapidly brought again under control with oral prednisone (1 mg/kg) therapy and a new loading scheme of infliximab therapy. Conclusion VKH disease results from an autoimmune process directed against melanocyte associated antigens which can be controlled when early and sustained immunosuppressive treatment is introduced. It seems that anti-SARS-CoV-2 vaccination can be at the origin of reactivation of long-time controlled disease.

scholarly journals Vogt-Koyanagi-Harada disease is always bilateral: reports of unilateral cases failed to use choroidal investigations showing subclinical involvement of the fellow eye

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ioannis Papasavvas ◽  
Carl P. Herbort
Keyword(s):  
Case Report ◽  
Indocyanine Green Angiography ◽  
Normal Values ◽  
Corticosteroid Injection ◽  
Slit Lamp ◽  
Autoimmune Process ◽  
Appropriate Treatment ◽  
Laser Flare ◽  
Stromal Choroiditis ◽  
Vkh Disease

Abstract Background/purpose Vogt-Koyanagi-Harada (VKH) disease is a primary stromal choroiditis and a bilateral granulomatous panuveitis which, if not treated early and properly, could have a deleterious evolution. The purpose of our case report is to demonstrate that “so called” unilateral VKH disease should be investigated further with an Indocyanine Green Angiography (ICGA), in order to detect subclinical choroidal involvement of the other eye. Case report We present a case of 42-year old woman who came to see us for second opinion. She had consulted elsewhere for a left uveitis and had been treated with a periocular corticosteroid injection. At presentation she mentioned persistent headaches. Visual acuity on the Snellen scale was 1.0 OD and 0.5 OS. Slit-lamp examination showed granulomatous (rare mutton-fat KPs) signs in her left eye. Laser flare photometry showed a subclinical flare of 17.8 ph/ms OD and a flare of 66.4 ph/ms OS (normal values 3–6 ph/ms). Fundus examination showed left discoloration due to choroidal infiltration with a normal fundus aspect OD. ICGA showed a diffuse choroiditis also in the apparently normal right eye. Lumbar puncture confirmed the diagnosis of VKH and appropriate treatment was introduced. Conclusion VKH disease results from a generalized autoimmune process against melanocyte associated antigens starting in the choroidal stroma. It can be asymmetrical but is always bilateral, as long as investigations such as ICGA, able to detect subclinical choroiditis, are performed.

Research on cargo-loading optimization based on genetic and fuzzy integration

2021 ◽  
Vol 40 (4) ◽  
pp. 8493-8500
Author(s):  
Yanwei Du ◽  
Feng Chen ◽  
Xiaoyi Fan ◽  
Lei Zhang ◽  
Henggang Liang
Keyword(s):  
Genetic Algorithm ◽  
Mathematical Model ◽  
Three Dimensional ◽  
Distribution Center ◽  
Long Time ◽  
Low Efficiency ◽  
Decision Making Model ◽  
The Mathematical Model ◽  
Loading Scheme

With the increase of the number of loaded goods, the number of optional loading schemes will increase exponentially. It is a long time and low efficiency to determine the loading scheme with experience. Genetic algorithm is a search heuristic algorithm used to solve optimization in the field of computer science artificial intelligence. Genetic algorithm can effectively select the optimal loading scheme but unable to utilize weight and volume capacity of cargo and truck. In this paper, we propose hybrid Genetic and fuzzy logic based cargo-loading decision making model that focus on achieving maximum profit with maximum utilization of weight and volume capacity of cargo and truck. In this paper, first of all, the components of the problem of goods stowage in the distribution center are analyzed systematically, which lays the foundation for the reasonable classification of the problem of goods stowage and the establishment of the mathematical model of the problem of goods stowage. Secondly, the paper abstracts and defines the problem of goods loading in distribution center, establishes the mathematical model for the optimization of single car three-dimensional goods loading, and designs the genetic algorithm for solving the model. Finally, Matlab is used to solve the optimization model of cargo loading, and the good performance of the algorithm is verified by an example. From the performance evaluation analysis, proposed the hybrid system achieve better outcomes than the standard SA model, GA method, and TS strategy.

scholarly journals New Perspectives on the Immunopathogenesis and Treatment of Uveitis Associated With Vogt-Koyanagi-Harada Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Ahmed M. Abu El-Asrar ◽  
Jo Van Damme ◽  
Sofie Struyf ◽  
Ghislain Opdenakker
Keyword(s):  
B Cells ◽  
Autoimmune Response ◽  
Therapeutic Window ◽  
High Dose ◽  
Exudative Retinal Detachment ◽  
Granulomatous Uveitis ◽  
Systemic Corticosteroids ◽  
Initial Onset ◽  
Vkh Disease

Uveitis associated with Vogt-Koyanagi-Harada (VKH) disease is a bilateral, chronic, granulomatous autoimmune disease associated with vitiligo, poliosis, alopecia, and meningeal and auditory manifestations. The disease affects pigmented races with a predisposing genetic background. Evidence has been provided that the clinical manifestations are caused by a T-lymphocyte-mediated autoimmune response directed against antigens associated with melanocytes in the target organs. Alongside of T lymphocytes, autoreactive B cells play a central role in the development and propagation of several autoimmune diseases. The potential role of B lymphocytes in the pathogenesis of granulomatous uveitis associated with VKH disease is exemplified within several studies. The early initial-onset acute uveitic phase typically exhibits granulomatous choroiditis with secondary exudative retinal detachment and optic disc hyperemia and swelling, subsequently involving the anterior segment if not adequately treated. The disease eventually progresses to chronic recurrent granulomatous anterior uveitis with progressive posterior segment depigmentation resulting in “sunset glow fundus” appearance and chorioretinal atrophy if not properly controlled. Chronically evolving disease is more refractory to treatment and, consequently, vision-threatening complications have been recognized to occur in the chronic recurrent phase of the disease. Conventional treatment with early high-dose systemic corticosteroids is not sufficient to prevent chronic evolution. Addition of immunomodulatory therapy with mycophenolate mofetil as first-line therapy combined with systemic corticosteroids in patients with acute initial-onset disease prevents progression to chronic evolution, late complications, vitiligo, and poliosis. Furthermore, patients under such combined therapy were able to discontinue treatment without relapse of inflammation. These findings suggest that there is a therapeutic window of opportunity for highly successful treatment during the early initial-onset acute uveitic phases, likely because the underlying disease process is not fully matured. It is hypothesized that early and aggressive immunosuppressive therapy will prevent remnant epitope generation in the initiation of the autoimmune process, the so-called primary response. B cell depleting therapy with the anti-CD20 monoclonal antibody rituximab is effective in patients with refractory chronic recurrent granulomatous uveitis. The good response after rituximab therapy reinforces the idea of an important role of B cells in the pathogenesis or progression of chronic recurrent uveitis associated with VKH disease.

Rates of immunosuppressive treatment and hospitalization after checkpoint inhibitor therapy in melanoma and lung cancer patients with autoimmune diseases.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e14140-e14140
Author(s):  
David Andrew Bender ◽  
Catherine Spina ◽  
Samuel P. Heilbroner ◽  
Eric Xanthopoulos ◽  
Tony J. C. Wang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Adverse Events ◽  
Autoimmune Diseases ◽  
Cancer Patients ◽  
Checkpoint Inhibitors ◽  
Oral Prednisone ◽  
Immunosuppressive Treatment ◽  
Lung Cancer Patients ◽  
Pharmacy Claims ◽  
Increased Risk

e14140 Background: Immune checkpoint inhibitors (ICIs) are known to cause immune-related adverse events. Patients with autoimmune diseases (AID) were excluded from most ICI clinical trials due to the potentially high risk of adverse effects. Data on the safety of ICIs in patients with a diagnosis of AID is therefore limited. Methods: A retrospective cohort study was conducted using a de-identified large oncology health care and pharmacy claims database with data from March 2010 until April 2017. Patients analyzed had a diagnosis of either melanoma or lung cancer and were treated with either of the anti-PD-1 inhibitors nivolumab or pembrolizumab. We assessed whether patients with AID compared with no AID were more likely to require medical interventions within 180 days of ICI therapy. We determined the percentage of patients receiving oral prednisone, IV methylprednisolone, or were hospitalized, which may represent responses to ICI toxicity. Results: 16.7% (16/96) of patients with either melanoma or lung cancer and AID received oral prednisone treatment within 180 days of ICI treatment, while 8.3% (131/1573) of patients without AID received oral prednisone during the same period. 8.4% (16/190) of patients with AID received IV methylprednisolone compared to 3.6% (79/2190) of patients without AID. Among melanoma patients, 24.1% (13/54) of patients with AID were hospitalized following ICI treatment, compared to 5.8% (28/480) of patients without ICI. Among lung cancer patients, 38.2% (52/136) of patients with AID were hospitalized compared to 31.6% (541/1711) of patients without AID. All comparisons are significant at p < 0.05 except hospitalizations in lung cancer patients. Conclusions: Patients with AID were more likely to receive interventions after ICI treatment that may represent responses to immune-related adverse events, suggesting that patients with AID are at increased risk for toxicity when being treated with ICIs.

scholarly journals Identification of Underlying Inflammation in Vogt–Koyanagi–Harada Disease with Sunset Glow Fundus by Multiple Analyses

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Toshihiko Murata ◽  
Nanae Sako ◽  
Kei Takayama ◽  
Kozo Harimoto ◽  
Koji Kanda ◽  
...  
Keyword(s):  
Ocular Inflammation ◽  
Enhanced Depth Imaging ◽  
Significant Prognostic Factor ◽  
Depth Imaging ◽  
Initial Onset ◽  
Sunset Glow Fundus ◽  
Laser Flare ◽  
Imaging Optical Coherence Tomography ◽  
The Mean ◽  
Clinical Records

Purpose. To evaluate underlying subclinical ocular inflammation in Vogt–Koyanagi–Harada (VKH) disease with sunset glow fundus (SGF) by multiple analyses. Study Design. Retrospective observational study. Methods. Clinical records of 34 eyes of 17 VKH patients with SGF in whom laser flare photometry (LFP), enhanced depth imaging optical coherence tomography (EDI-OCT), and indocyanine green angiography (ICGA) were performed on the same day were reviewed. The mean age was 57.3 ± 16.3 years, and the mean duration from the initial onset of uveitis was 47.1 ± 22.1 months. Flare counts, ICGA scores, and subfoveal choroidal thickness (SFCT) were compared between eyes. Results. Although clinical ocular inflammation was observed only in 4 eyes (11.8%), inflammatory signs were observed in 23 out of 34 eyes by LFP (67.6%), in 27 eyes by ICGA (79.4%), and in 10 eyes by SFCT (29.4%). Active inflammatory signs detected by ICGA were observed in 77.8% by LFP and in 25.9% by SFCT. The strength of agreement (Cohen’s kappa coefficient) between positive ICGA score and positive flare score was 0.406 (95% CI: 0.076–0.7359, P<0.01), but there was no association between positive ICGA score and increased SFCT. In addition, positive flare count was the significant prognostic factor of positive ICGA score with odds ratio 11.7. Conclusions. Subclinical ocular inflammation signs were detected in most VKH patients with SGF by ICGA and a substantial proportion of which were also detected by LFP, whereas SFCT was less sensitive to detect subclinical inflammation.

scholarly journals Initial-onset acute and chronic recurrent stages are two distinctive courses of Vogt-Koyanagi-Harada disease

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Cristhian A. Urzua ◽  
Carl Herbort ◽  
Rodrigo A. Valenzuela ◽  
Ahmed M. Abu El-Asrar ◽  
Lourdes Arellanes-Garcia ◽  
...  
Keyword(s):  
Recurrent Disease ◽  
International Committee ◽  
Disease Symptoms ◽  
Delay In Diagnosis ◽  
Clinical Presentations ◽  
Current Classification ◽  
Initial Onset ◽  
Characteristic Features ◽  
Anatomical Outcomes ◽  
Vkh Disease

Abstract Purpose To describe distinctive stages of Vogt-Koyanagi-Harada (VKH) disease: initial-onset acute versus chronic recurrent disease. Methods A comprehensive literature review regarding stages and clinical presentations of VKH disease was conducted. Results Despite a list of signs that has been described as characteristic features of early or late phases of VKH disease, the current classification -developed by an international committee and published in 2001- does not consider a distinction regarding the time from onset of disease symptoms, and specific findings observed at certain time point from the symptoms presentation and outcomes related to the stage of VKH disease. In that sense, chronic recurrent VKH disease is more refractory to treatment and is associated with a higher rate of complications. Accordingly, this subset of VKH patients has poorer functional and anatomical outcomes than patients with an initial-onset acute disease. Conclusions An early clear distinction of VKH phenotype [Initial-onset acute versus chronic recurrent disease] should be considered in each clinical scenario, evaluating the delay in diagnosis and the clinical presentation, since it may help clinicians to perform a correct disease prognosis categorization and thus to make treatment decisions in terms of potential refractoriness or expected clinical outcomes.

Non-invasive method of monitoring retinal vasculitis in patients with birdshot chorioretinopathy using optical coherence tomography

2017 ◽  
Vol 102 (6) ◽  
pp. 815-820 ◽  
Author(s):  
Jared E Knickelbein ◽  
William Tucker ◽  
Shilpa Kodati ◽  
Marib Akanda ◽  
H Nida Sen
Keyword(s):  
Optical Coherence Tomography ◽  
Initial Treatment ◽  
Oral Prednisone ◽  
Immunosuppressive Treatment ◽  
Retinal Vasculitis ◽  
Vascular Leakage ◽  
Large Vessel ◽  
Optical Coherence ◽  
Thickness Change ◽  
Birdshot Chorioretinopathy

Background/aimsTo investigate the utility of using montaged optical coherence tomography (OCT) thickness maps to monitor perivascular thickness as a marker of vasculitic activity in patients with large-vessel retinal vasculitis.MethodsThis is a retrospective cohort study of 22 eyes of 11 patients with a history of retinal vasculitis associated with birdshot chorioretinopathy (BCR). Patients had serial spectral domain 6×6 mm cube OCT scans centred on the fovea, optic nerve and proximal branches of the superior and inferior retinal vessels. OCT thickness change maps for each respective region were analysed. Changes in perivascular thickness were confirmed by assessing vasculitic activity on fluorescein angiography (FA), when clinically indicated.ResultsIn three patients, montaged OCT scans were acquired at diagnosis and serially through initial treatment. In all three patients, montaged OCT demonstrated reduced perivascular thickening with oral prednisone treatment, which was confirmed by FA showing reduced vascular leakage in both eyes. Eight patients had serial montaged OCT scans after diagnosis and initial treatment of BCR. Four of these patients showed fluctuations in perivascular thickness during flares and treatment that were confirmed by either increased or decreased vascular leakage on FA. The other four patients remained quiet on their immunosuppressive treatment regimens, and no changes in perivascular thickness were detected.ConclusionsEvaluating large-vessel perivascular thickness on OCT scans may be a useful method for non-invasively monitoring posterior pole large-vessel retinal vasculitis.

scholarly journals Role of Myokines in Myositis Pathogenesis and Their Potential to be New Therapeutic Targets in Idiopathic Inflammatory Myopathies

2020 ◽  
Vol 2020 ◽  
pp. 1-14 ◽  
Author(s):  
Vlad Mageriu ◽  
Emilia Manole ◽  
Alexandra E. Bastian ◽  
Florica Staniceanu
Keyword(s):  
Skeletal Muscle ◽  
Inflammatory Process ◽  
Immunosuppressive Treatment ◽  
Therapeutic Targets ◽  
Idiopathic Inflammatory Myopathies ◽  
Inflammatory Myopathies ◽  
Autoimmune Process ◽  
Antagonistic Action ◽  
Scientific Approach

Idiopathic inflammatory myopathies (IIM) represent a heterogeneous group of autoimmune diseases whose treatment is often a challenge. Many patients, even after immunosuppressive therapy, do not respond to treatment, so new alternatives have been sought for this. Therefore, other signaling pathways that could contribute to the pathogenesis of myositis have been investigated, such as the expression of myokines in skeletal muscle in response to the inflammatory process. In this review, we will refer to these muscle cytokines that are overexpressed or downregulated in skeletal muscle in patients with various forms of IIM, thus being able to contribute to the maintenance of the autoimmune process. Some muscle cytokines, through their antagonistic action, may be a helpful contributor to the disease modulation, and thus, they could represent personalized treatment targets. Here, we consider the main myokines involved in the pathogenesis of myositis, expressing our view on the possibility of using them as potential therapeutic targets: interleukins IL-6, IL-15, and IL-18; chemokines CXCL10, CCL2, CCL3, CCL4, CCL5, and CCL20; myostatin; follistatin; decorin; osteonectin; and insulin-like 6. An interesting topic regarding the complex connection between myokines and noninflammatory pathways implied in IIM has also been briefly described, because it is an important scientific approach to the pathogenesis of IIM and can be a therapeutic alternative to be considered, especially for the patients who do not respond to immunosuppressive treatment.

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