The Vogt-Koyanagi-Harada and SAPHO Syndrome: An Unusual Association

Vogt-Koyanagi-Harada syndrome(VKH) is a multisystemic disorder characterized by granulomatous panuveitis and cutaneous, otorhynolaryngologic and neurologic involvement, due to an autoimmune reaction against melanocytic antigens. Autoinflammatory associations of VKH, including inflammatory bowel disease and psoriasis, were rarely described. SAPHO syndrome (an acronym for synovitis, acne, hyperostosis, pustulosis and osteitis) is a rare autoinflammatorymusculo-scheletal disease. This paper reports on a male patient presenting for long-lasting bone and joint pain, dysphagia,having a ten-year history of bilateral optic neuritiswhich required high-dose corticosteroids. Fundoscopy revealed diffuse chorioretinalnonpigmented atrophic lesions. Vitiligo, acne scars, clavicular deformity, recurrent chest pain and sacroiliitis pointed to a long-standing SAPHO syndrome and late-phase VKH. Blood tests found inflammation and anti-hepatitis C antibodies with repeatedly undetectable viremia. Bone scintigraphy with the characteristic bull�s head upper chest uptake and the radiographs confirmed SAPHO syndrome. The patient was treated with sulphasalazine and cyclosporin A, with alleviation of the articular and bony disease. In conclusion, SAPHO syndrome may add to the list of the diseases associated with VKH. Although VKH and SAPHO syndrome may have appeared coincidentally, a common pathogenesis involving an infectious trigger and IL-17 could be considered.