A Case of Recalcitrant Pediatric Vogt-Koyanagi-Harada Disease Successfully Controlled with Adalimumab

In a 2019 case report, a 12-year-old patient with Vogt-Koyanagi-Harada (VKH) disease, an autoimmune condition affecting the eyes, achieved remission through the use of adalimumab. This treatment was pursued after conventional therapies, including high-dose systemic corticosteroids, intravitreal triamcinolone injection, and mycophenolate mofetil, failed to control the patient's ocular inflammation. The successful use of adalimumab, which is FDA-approved for adult uveitis but not for pediatric use, led to improved vision and the reduction of systemic corticosteroids. The case underscores the potential of escalating immunosuppression in pediatric VKH and the need for further investigation into the treatment's pathophysiology and the role of anti-tumor necrosis factor-alpha agents. Concerns about the increased risk of malignancy with biological response modifiers like adalimumab were mentioned, but no causal relationship has been established, indicating a need for more research on the safety and efficacy of such treatments in children with VKH.