Melanin-laden macrophages in the CSF to diagnose Vogt-Koyanagi-Harada simulating ocular syphilis.
OBJECTIVE
To describe a case of Vogt-Koyanagi-Harada (VKH) disease initially presenting as ocular syphilis.


METHODS
A 51-year-old woman presented with counting fingers vision in both eyes. She underwent a complete ophthalmic examination, serological testing, fluorescein angiography, and CSF analysis.


RESULTS
Serological testing revealed positive titers for syphilis. Fluorescein angiography demonstrated findings suggesting VKH. CSF cytology showed macrophages containing melanin granules consistent with VKH. Subsequent treatment with corticosteroids and cyclosporine resulted in significant improvement of vision.


CONCLUSIONS
The presence of melanin-laden macrophages within the CSF allows for the differentiation of VKH from ocular syphilis.
Kim
Leo A
LA
Doheny Eye Institute, Department of Ophthalmology, University of Southern California, Los Angeles, California 90033, USA.
Khurana
Rahul N
RN
Parikh
Jignesh G
JG
Rao
Narsing A
NA
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D003937:Diagnosis, Differential; D015818:Eye Infections, Bacterial / Q000175:diagnosis*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008264:Macrophages / Q000378:metabolism*; D008543:Melanins / Q000134:cerebrospinal fluid*; D008875:Middle Aged; D013587:Syphilis / Q000175:diagnosis*; D014607:Uveomeningoencephalitic Syndrome / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D014785:Vision, Ocular / Q000187:drug effects
D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D008543:Melanins; D016572:Cyclosporine