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Revising the role of cerebrospinal fluid pleocytosis as a diagnostic criterion in Vogt-Koyanagi-Harada disease

Eye volume 39, pages 2334–2336 (2025)Cite this article

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Vogt-Koyanagi-Harada (VKH) disease is a multisystemic inflammatory condition presenting with bilateral panuveitis, serous retinal detachments, and extraocular features, encompassing skin and central nervous system (CNS) involvement. Diagnosis relies on a set of diagnostic criteria, including cerebrospinal fluid (CSF) pleocytosis [1]. However, while CSF analysis has traditionally been considered a diagnostic tool [2], its utility in VKH disease remains questionable. An elevated CSF leukocyte count (i.e., CSF pleocytosis) is a nonspecific finding in a broad spectrum of conditions, including infectious, inflammatory, autoimmune, metabolic, traumatic, degenerative, and malignant diseases [2, 3]. The overlapping nature of CSF characteristics among these conditions limits its specificity, often leading to unnecessary lumbar puncture (LP), without significantly improving diagnostic accuracy.

Importantly, CSF pleocytosis is not a reliable indicator of CNS inflammatory disease, as it may be present in subjects without CNS involvement and absent in severe CNS infections [2,3,4]. While specific CSF biomarkers, rather than pleocytosis alone, have shown diagnostic value in conditions like multiple sclerosis [5], their relevance in VKH disease remains uncertain and contradictory [5, 6]. Although CSF analysis is a key tool for assessing CNS inflammation, its role in autoimmune diseases such as VKH is questionable.

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Author information

Authors and Affiliations

  1. Laboratory of Ocular and Systemic Autoimmune Diseases, Faculty of Medicine, University of Chile, Santiago, Chile

    Cristhian A. Urzua & Marcelo Vega-Codd

  2. Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile

    Cristhian A. Urzua

  3. Red de Investigación en Inmunología Ocular de Latinoamerica (RIOLAT), Santiago, Chile

    Cristhian A. Urzua, Ariel Schlaen, Cristobal Couto, Lourdes Arellanes-Garcia, Andre Curi, Alejandra de-la-Torre & Luz E. Concha-del-Rio

  4. Moorfields Eye Hospital NHS Foundation Trust, London, UK

    Carlos Pavesio

  5. Department of Ophthalmology, Hospital de Clinicas Jose de San Martin, Universidad de Buenos Aires, Buenos Aires City, Argentina

    Ariel Schlaen & Cristobal Couto

  6. Department of Ophthalmology, Hospital Universitario Austral, Buenos Aires, Argentina

    Ariel Schlaen

  7. Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialised Care (COS), Lausanne, Switzerland

    Carl P. Herbort Jr

  8. Inflammatory Eye Disease Clinic, Hospital Dr. Luis Sanchez Bulnes, Asociación para Evitar la Ceguera en, México, México

    Lourdes Arellanes-Garcia & Luz E. Concha-del-Rio

  9. Clinical Research Laboratory of Infectious Diseases, Ophthalmology, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil

    Andre Curi

  10. Neurosciences Research Group (NEUROS), NeuroVitae Research Center, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia

    Alejandra de-la-Torre

  11. Department of Ophthalmology, Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia

    Ahmed M. Abu El-Asrar

Authors
  1. Cristhian A. Urzua
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  2. Marcelo Vega-Codd
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  3. Carlos Pavesio
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  4. Ariel Schlaen
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  5. Carl P. Herbort Jr
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  6. Cristobal Couto
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Contributions

All authors have made substantial contributions to the conception, design of the work, the acquisition, analysis, or interpretation of data for the work; AND Drafting the work and revising it critically for important intellectual content; AND Final approval of the version to be published.

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Correspondence to Cristhian A. Urzua.

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Urzua, C.A., Vega-Codd, M., Pavesio, C. et al. Revising the role of cerebrospinal fluid pleocytosis as a diagnostic criterion in Vogt-Koyanagi-Harada disease. Eye 39, 2334–2336 (2025). https://doi.org/10.1038/s41433-025-03892-1

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