Vogt-Koyanagi-Harada disease developed during chemotherapy for Hodgkin lymphoma: a case report.

BACKGROUND: Ocular manifestations are known for non-Hodgkin lymphoma, but are rare for Hodgkin lymphoma. We report a case of Vogt-Koyanagi-Harada (VKH) disease presenting as serous retinal detachment and uveitis in both eyes in a child undergoing chemotherapy for Hodgkin lymphoma. CASE PRESENTATION: The patient was a 7-year-old boy with stage IIB Hodgkin lymphoma (nodular lymphocyte predominant type) who was undergoing chemotherapy, including 2 cycles of the OEPA regimen and 1 cycle of the COPDAC regimen. Two days after the end of the COPDAC regimen, the patient complained of headache and of blurred and decreased vision in both eyes. On the basis of optic symptoms, such as uveitis and serous retinal detachment in both eyes, increased cell counts in cerebrospinal fluid, and positivity for human leukocyte antigen (HLA)-DR4 in peripheral blood cells, incomplete VKH disease was diagnosed. Intravenous treatment with high-dose prednisolone (60mg/m2/day) for 7 days improved both visual acuity and serous retinal detachment and enabled the remains of the COPDAC chemotherapy cycle to be administered. With prednisolone treatment, visual acuity improved from 20/500 to 20/20 in the right eye and from 20/63 to 20/25 in the left eye. Because multiple vitiligo lesions later appeared in the abdomen, complete VKH disease was finally diagnosed. CONCLUSION: The onset of VKH disease occurred during chemotherapy for Hodgkin lymphoma. The patient was HLA-DR4-positive and might have had a predisposition to develop autoimmune diseases, including VKH disease. However, the anticancer drugs administered to this patient have not been reported to cause uveitis. Whether Hodgkin lymphoma triggered the development of VKH remains unclear. Early diagnosis of VKH disease and prompt treatment with high-dose prednisone enabled the patient to maintain good visual function despite chemotherapy for Hodgkin lymphoma.

Chemokine/Interleukin Imbalance Aggravates the Pathology of Respiratory Syncytial Virus Infection.

(1) Background: Almost 100% of children are initially infected by respiratory syncytial virus (RSV) by the age of 2 years, with 30% to 40% of children developing lower respiratory tract infections, of which 1% to 3% become severe. The severity of RSV-induced disease correlates with the influx of leukocytes, which leads to damage of the airways. We hence performed an immunological study based on the assumption that a chemokine/interleukin imbalance affects respiratory disorders caused by bronchiolitis and severe pneumonia. (2) Methods: The subjects were 19 infants without any underlying diseases, who developed respiratory symptoms owing to RSV infection. The subjects were stratified by their symptom severity, and chemokine and interleukin levels in their serum and tracheal aspirate fluid (TAF) were measured. (3) Results: The data of TAF, which were only obtained from subjects with severe symptoms, indicated that levels of inflammatory interleukins were much lower than the levels of chemokines. Three out of 6 subjects with severe symptoms showed below detectable levels of IL-6. TNF-α and IFN-γ levels were also lower than those of chemokines. The main increased CCL chemokines were CCL21 and CCL25, and the main increased CXCL chemokines were CXCL5, 8, 10, 12, and CX3CL1 in the lower respiratory region. Multiple regression analysis demonstrated that serum CX3CL1 and IL-6 levels were most strongly associated with symptom severity. This is the first report to date demonstrating that serum CX3CL1 level is associated with the severity of RSV infection. (4) Conclusions: Our results demonstrated that specific chemokines and the imbalance of cytokines are suspected to be associated with aggravated symptoms of RSV infection.