REPORT OF A CASE
A 48-year-old black woman of American Indian heritage noted sudden bilateral visual loss preceded by 3 weeks of orbital pain. Ocular examination revealed visual acuity of 20/50 OD and 20/30 OS, bilateral iritis, discrete cream-colored choroidal lesions, and an exudative retinal detachment in the right eye (Figure 1). Fluorescein angiography revealed bilateral focal areas of leakage at the level of the retinal pigment epithelium with staining of the optic nerve head (Figure 2). Ocular echography demonstrated choroidal thickening and exudative retinal detachment. General physical examination revealed vitiligo (Figure 3) and, over the right eye, a white eyelash (Figure 4). Laboratory evaluation was normal.What is your diagnosis?
Vogt-Koyanagi-Harada (VKH) syndrome (uveoencephalitis).
Treatment with oral prednisone (100 mg/d), topical ophthalmic 1% prednisolone acetate hourly, and topicalopthalmic 1% prednisolone acetate hourly, and topical ophthalmic 1% atropine sulfate improved the symptoms within
Heier JS, Uyemura M, Enzenauer RW, Enzenauer RJ, Waterhouse WJ. Vision Loss in a Woman of American Indian Heritage. Arch Dermatol. 1995;131(1):86. doi:10.1001/archderm.1995.01690130089018