Pigmentary disorders: Vogt-Koyanagi-Harada disease: practice question

A Dermatology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Dermatology · Pigmentary disorders: Vogt-Koyanagi-Harada disease

Sample item

A 35-year-old develops bilateral uveitis with headache, tinnitus and neck stiffness. Weeks later she has patchy poliosis of the eyelashes and depigmented patches on the trunk. What is the underlying process?

AAutoimmune attack on melanocytes in the uvea, skin, hair and inner earBGranulomatous infiltration by Mycobacterium lepraeCAutoantibodies against desmoglein 3 in the epidermisDImmune complex vasculitis of small vessels

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Autoimmune attack on melanocytes in the uvea, skin, hair and inner ear

Vogt-Koyanagi-Harada disease is a T-cell mediated autoimmune attack against melanocytes. It presents with bilateral granulomatous uveitis, meningism, tinnitus or hearing loss, then poliosis and vitiligo in the convalescent phase. Early high-dose corticosteroids are the mainstay of treatment.

Option by option

A. Autoimmune attack on melanocytes in the uvea, skin, hair and inner ear (correct)
Correct. Melanocyte-directed autoimmunity explains the uveitis, deafness, poliosis and vitiligo.
B. Granulomatous infiltration by Mycobacterium leprae
Leprosy does not cause bilateral uveitis with meningism and poliosis in this pattern.
C. Autoantibodies against desmoglein 3 in the epidermis
Desmoglein 3 antibodies cause pemphigus vulgaris, a blistering disease without uveitis.
D. Immune complex vasculitis of small vessels
Small vessel vasculitis gives palpable purpura, not poliosis and depigmentation.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Dermatology question

What is the answer to this Dermatology question?

The best answer is A, Autoimmune attack on melanocytes in the uvea, skin, hair and inner ear. Vogt-Koyanagi-Harada disease is a T-cell mediated autoimmune attack against melanocytes.

Why is "Granulomatous infiltration by Mycobacterium leprae" not the answer?

Leprosy does not cause bilateral uveitis with meningism and poliosis in this pattern.

Why is "Autoantibodies against desmoglein 3 in the epidermis" not the answer?

Desmoglein 3 antibodies cause pemphigus vulgaris, a blistering disease without uveitis.

Why is "Immune complex vasculitis of small vessels" not the answer?

Small vessel vasculitis gives palpable purpura, not poliosis and depigmentation.

What concept does this question test?

It tests Pigmentary disorders: Vogt-Koyanagi-Harada disease in Dermatology. It presents with bilateral granulomatous uveitis, meningism, tinnitus or hearing loss, then poliosis and vitiligo in the convalescent phase. Early high-dose corticosteroids are the mainstay of treatment.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Pigmentary disorders: Vogt-Koyanagi-Harada disease?

Learn each condition by its primary lesion, site and signature sign. Then use the flashcards and the other Dermatology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.