![]() ![]() MRI brain showed deep white matter lesions in the parietal lobes which were previously described as radiologic features of VKH syndrome. ![]() Our index case did not have any skin, auditory, or neurological manifestations except for headache. The revised international classification of VKH is divided into incomplete, complete, and probable based on the systemic and ocular features. Serological screen for syphilis, tuberculosis, and hepatitis viruses were negative. Full blood count was normal, and peripheral blood smear showed no significant morphologic abnormalities suggestive of hematopoietic tumor. Magnetic resonance imaging (MRI) brain showed scattered foci of T2/FLAIR hyper intensities in the bilateral centrum semiovale, bilateral corona radiata, and subcortical and deep white matter of both frontal and parietal lobes. ![]() Differentials that were considered in our index case included leukemia, lymphoma, and syphilis. Clinical findings, OCT, and fluorescein angiography features are all typical of acute uveitic phase of VKH disease except for the presence of retinal hemorrhages. Fundus fluorescein angiography showed early blocked fluorescence with multiple pin-point leakages in the middle phases with placoid areas of hyperfluoresence in late phases (Fig. 2a) and RPE undulations with pockets of subretinal fluid (Fig. Optical coherence tomography (OCT) macula showed areas of serous detachment (Fig. No evidence of vessel sheathing was seen (Fig. Fundus showed bilateral exudative retinal detachment with pockets of subretinal fluid in the posterior pole mainly superiorly and inferotemporally, with dot and blot hemorrhages seen around fovea, temporal to macula, and superior to disc. Slit lamp examination showed anterior chamber reaction with cells occasionally in both eyes, no keratic precipitates were seen, lens was clear, and anterior vitreous face showed cells 1+ retrolentally. There was no relative afferent pupillary defect. On examination, her best corrected visual acuity was counting fingers closely in both eyes her intra ocular pressures were within normal limits. No previous history of any ocular surgery or trauma was noted. There was no uveitis-related systemic history in the form of joint pains, exposure to tuberculosis, exposure to pets, or fever with rashes. There was no evidence of any associated systemic illness. No associated history of redness, photophobia, and floaters was noted. We present this case for its unusual presentation.Ī 56-year-old lady was presented to the emergency clinic with acute onset of headache since 3 days followed by sudden progressive loss of vision in both eyes. No specific cause for the presence of retinal hemorrhages was found, which also resolved with treatment. We report a case of primary VKH syndrome in acute uveitic stage, with bilateral serous retinal detachment with multiple retinal hemorrhages which resolved completely with systemic corticosteroids. The recurrent phase consists of a panuveitis with acute exacerbations of anterior uveitis. The chronic or convalescent phase is characterized by the development of vitiligo, poliosis, and depigmentation of the choroid and usually occurs weeks after the acute uveitic phase. Exudative bilateral retinal detachments are usually noted in the acute uveitic phase which responds well to high dose of corticosteroids. It usually presents in four phases-prodromal phase, acute uveitic phase, chronic or convalescent phase, and recurrent phase. The incidence of VKH among Singaporean population in referral care centre was found to be 3%. Vogt-Koyanagi-Harada syndrome (VKH), an autoimmune disorder, is an oculocutaneous meningeal syndrome commonly seen in pigmented race population characterized usually by bilateral granulomatous panuveitis, often associated with neurological, auditory, and cutaneous manifestations. ![]()
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