Work-up, diagnosis and management of acute Vogt-Koyanagi-Harada disease: a case of acute myopization with granulomatous uveitis.
OBJECTIVE
In its typical form and when seen at onset, Vogt-Koyanagi-Harada (VKH) is characterized by easily recognizable signs that allow diagnosis without difficulty. In cases that do not have acute onset, that are seen at a later stage or that do not show the complete set of signs, appraisal is more difficult and diagnosis may cause difficulties. We present here a case of bilateral granulomatous uveitis compatible with VKH disease in order to allow several experts to give their opinion on the most appropriate manner to confirm or reject the diagnosis and their approach to the management of the case.


METHODS
A 17-year-old female patient consulted her ophthalmologist for blurred vision OU following an episode of a flu-like disease with malaise, fever and headaches. A bilateral anterior granulomatous uveitis with a right papillitis was diagnosed and the patient presented with a bilateral acute myopization. Fluorescein angiography showed right disc hyperfluorescence with late leakage and slight left disc hyperfluorescence. The patient was given a course of one week of peroral corticosteroid therapy followed by an intramuscular injection of Bentelan twice weekly. In the absence of significant improvement the patient was sent six weeks later to a specialized center where a complete work-up was performed.


CONCLUSIONS
The diagnostic work-up, investigational tests, and differential diagnosis to confirm or reject the diagnosis of VKH as well as the management of the case will be described by the experts.
Mantovani
Alessandro
A
Unit of Ophthalmology, Ospedale Valduce, Como, Italy.
Resta
Anna
A
Herbort
Carl P
CP
Abu El Asrar
Ahmed
A
Kawaguchi
Tatsushi
T
Mochizuki
Manabu
M
Okada
Annabelle A
AA
Rao
Narsing A
NA
D000208:Acute Disease; D000293:Adolescent; D001379:Azathioprine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005451:Fluorescein Angiography; D005938:Glucocorticoids / Q000627:therapeutic use; D006099:Granuloma / Q000175:diagnosis*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007208:Indocyanine Green; D008775:Methylprednisolone / Q000627:therapeutic use; D033401:Microscopy, Acoustic; D009216:Myopia / Q000175:diagnosis*; D041623:Tomography, Optical Coherence; D014606:Uveitis, Anterior / Q000175:diagnosis*; D014607:Uveomeningoencephalitic Syndrome / Q000175:diagnosis* / Q000188:drug therapy*; D014794:Visual Fields
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D007208:Indocyanine Green; D001379:Azathioprine; D008775:Methylprednisolone