A Clinical Case from the Archives : 26/05/2006

Today this Akita turns up in the clinic with erosive lesions around its eyes and muzzle and an anterior uveitis, not with miosis particularly but with a muddy looking iris and intraocular pressures below 10mmHg. What might this be and how would you treat it?

My suspicion is that this is Vogt-Koyanagi-Harada-like syndrome seen in the Japanese Akita, although normally the periocular disease is poliosis and vitiligo (whitening of the hair and skin) rather than these erosive lesions and the uveitis is posterior with a blinding choroiditis and retinal detachment not anterior with keratitis as here. Tom Kern was I think the first person to report several dogs with the problem back in the 1980s (Uveitis associated with poliosis and vitiligo in six dogs. Journal American Veterinary Medical Association 187:408-14. ) but two more recent papers which might interest you include one linking the disease to a specific dog leucocyte antigen haplotype (Angles et al (2005)Uveodermatologic (VKH-like) syndrome in American Akita dogs is associated with an increased frequency of DQA1*00201. Tissue Antigens 66:656-65). Another group experimentally induced the disease, showing that Akitas immunised with tyrosinase related protein 1 developed the condition (Yamaki et al (2005)Experimentally induced Vogt-Koyanagi-Harada disease in two Akita dogs. Exp Eye Res. 80:273-80) showing the similarity to the condition in man where this molecule has been found to be the key autoantigen in the disease. To get back to our case, we have treated the dog with oral prednisolone and azathioprine to reduce the inflammatory lesions: the condition normally needs a substantial immunosupressive onslaught to resolve it.


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