title: A Rare Case of Unilateral Progressive Vision Loss and Pachymeningitis.
abstract: We describe a 32-year-old man with presumed Vogt-Koyanagi Harada (VKH) syndrome, whose presenting symptoms were headache and progressive loss of vision in the right eye. Neuro-ophthalmic examination showed anterior and posterior uveitis, and retinal detachment in the right eye. Ocular coherence tomography (OCT) showed extensive submacular fluid in the right eye, while the fundus fluorescein angiogram (FFA) confirmed perifoveal retinal pigment epithelium (RPE) disruption and multifocal fluorescein leakage in the right eye. The brain MRI showed a small crescent of dependent fluid layering in the right posterior globe adjacent to the right optic nerve head, and pachymeningeal enhancement of the skull base dura along the clivus.This case demonstrates the utility of brain MRI and OCT findings in the early diagnosis of VKH syndrome, in the absence of prominent clinical signs of meningitis. Aggressive treatment is critical to preserve vision and prevent development of other systemic complications of the disease.
authors.affiliation: Department of Neurology, University of Illinois College of Medicine, Peoria, Peoria, Illinois, USA; Illinois Neurologic Institute, Peoria, Illinois, USA.
authors.forename: Reuben Mari
authors.initials: RM
authors.lastname: Valenzuela
authors.affiliation: Illinois Neurologic Institute , Peoria, Illinois, USA.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Keung
authors.affiliation: Department of Neurology, University of Illinois College of Medicine, Peoria, Peoria, Illinois, USA; North Shore University Health System, Glenview, Illinois, USA.
authors.forename: John H
authors.initials: JH
authors.lastname: Pula
authors.affiliation: Department of Neurology, University of Illinois College of Medicine, Peoria, Peoria, Illinois, USA; Illinois Neurologic Institute, Peoria, Illinois, USA.
authors.forename: Jorge C
authors.initials: JC
authors.lastname: Kattah
keywords: Pachymeningitis; Vogt-Koyanagi-Harada (VKH) disease; progressive visual loss