Vogt-Koyanagi-Harada disease and fungal meningitis.
OBJECTIVE
To describe a patient who initially presented with features of Vogt-Koyanagi-Harada disease and who eventually demonstrated symptoms of mycotic meningitis.


METHODS
An 18-year-old immunocompetent boy showed a disseminated uveitis with patchy thickening of the posterior choroid. A clinical neurologic examination and a microbiological assessment revealed neck stiffness as well as pleocytosis, increased protein content, a decreased concentration of glucose and chloride, and cryptococcal fungi in the cerebrospinal fluid. It led to the diagnosis of cryptococcal meningitis.


RESULTS
Antifungal therapy was initiated and given for 2 months. After bilateral retrobulbar injections of 2.5 mg of dexamethasone and 20 mg of triamcinolone acetonide, choroidal edema regressed and visual acuity increased from 0.4 to 1.0 at 3 weeks after start of therapy. Microbiological examination of cerebrospinal fluid samples taken 30 days later was unremarkable. Ophthalmoscopy showed some fine pigment clumping and depigmentation in the macula.


CONCLUSIONS
According to the International Nomenclature Committee for Vogt-Koyanagi-Harada diagnosis, the patient was diagnosed with incomplete Vogt-Koyanagi-Harada because he had not suffered any ocular trauma, had not undergone ocular surgery, and presented with bilateral multifocal choroiditis accompanied by signs of meningitis without skin abnormalities. Because skin changes can occur months to years after the initial symptoms, the patient may eventually fulfill the criteria for complete Vogt-Koyanagi-Harada disease.
*Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China; †Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Sciences Key Laboratory, and ‡Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China; and §Department of Ophthalmology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany.
Qi Sheng
QS
You
Xiao Yan
XY
Peng
Xiao Jun
XJ
Zhang
Chao
C
Meng
Jing Ting
JT
Peng
Jost B
JB
Jonas