Adalimumab in Vogt-Koyanagi-Harada disease: Case report and literature review

Vogt-Koyanagi-Harada syndrome is a rare autoimmune disease primarily affecting pigmented tissues with frequent ocular complications. Early and aggressive control of intraocular inflammation is essential, typically involving corticosteroids and immunosuppressive agents. 
Biologic therapies, especially adalimumab, have shown promise in refractory cases, supporting their use to prevent relapses and reduce corticosteroid dependence. 
We report a clinical case about 13-year-old female, manifesting as sudden bilateral vision loss and ocular inflammation. Initial examination revealed significant visual impairment, bilateral conjunctival hyperemia, granulomatous panuveitis, and serous retinal detachments. Angiographic findings showed characteristic papillary edema and multiple subretinal exudative lesions. All systemic, infectious, and immunological investigations returned normal results, leading to a diagnosis of the "possible" ocular isolated form of VKH. Standard treatment with high-dose corticosteroids and azathioprine resulted in recurrent, steroid-dependent uveitis. Introduction of adalimumab biotherapy achieved complete functional recovery, restoring visual acuity to 10/10 in both eyes, resolving retinal detachments, and leaving only residual pigment epithelium alterations. 
This case highlights the efficacy of TNF-alpha inhibitors in managing refractory ocular VKH and achieving corticosteroid sparing.