Diagnostic and prognostic value of cerebrospinal fluid analysis in Vogt-Koyanagi-Harada syndrome

Purpose To evaluate the diagnostic and prognostic values of lumbar puncture in Vogt-Koyanagi-Harada (VKH) syndrome. Methods Medical records of patients seen in a single tertiary center between 1995 and 2013, with confirmed VKH syndrome according to the Revised Diagnostic Criterias, were retrospectively reviewed. Clinical stage of the disease, cerebrospinal fluid (CSF) analysis, therapeutic strategy, and prognosis were compared. Results 68 patients with a confirmed diagnosis of VKH disease were initially reviewed. Among them, 29 patients (42%) had undergone a lumbar puncture (LP). 21 LP (72.4%) were performed at the early stage of the disease, and 11 were performed at the chronic stage of the disease (37.6%). 16 patients (55%) had a pleiocytosis. LP was abnormal in 66,7% at the acute phase and 27% at the chronic phase. An average of 62.3 lymphocytes /mm3 was observed when LP was performed during the acute phase and an average of 9.5 lymphocytes / mm3 was observed during the chronic phase ( p = 0,03). For two cases, the patient met the diagnostic criteria because of the LP findings. Patients dependant on low doses of steroids ( 5mg/d) ( 29,3 lymphocytesmm3) (p=0.03) when LP was performed at the acute phase of the disease. Conclusion The number of lymphocytes in the CSF at the diagnostic phase seems to be one of the prognostic factors for the outcome of VKH. Patients with a low pleiocytosis in the initial lumbar puncture should be closely monitored and may require a more aggressive treatment. Those conclusions must be confirmed with a prospective study.