Vogt-Koyanagi-Harada Syndrome: case report

Context: Red eye complaints are common in medical practice. Trauma, infection and autoimmune disorders are possible causes. It is essential to diagnose early to avoid sequelae. Case report: Female, 58 years old, 30 days of progression of bilateral frontal and retro-orbital headache associated with red eye and decreased visual acuity in both eyes, otalgia and tinnitus in the left ear. No trauma history. She started treatment in another hospital with acyclovir for suspected viral meningitis and was referred for evaluation after 10 days due to the lack of improvement. In our evaluation, the patient had severely impaired visual acuity (counted fingers in the RE and 20/400 in the LE), with uveitis, papilloedema and bilateral serous retinal detachment. Lumbar puncture showed aseptic meningitis (940 leukocytes with 100% lymphocytes, 66 mg/dL proteins, normal glucose and negative evaluation for CSF infections). Laboratory tests showed an increase in inflammatory markers (VSG 121) and positive anti-TPO, with other negative autoantibodies. Brain MRI with subacute retinal detachment, without intracranial lesions. Audiometry with mild to moderate bilateral sensorineural hearing loss. The patient was treated with IV methylprednisolone for 5 days with partial symptom improvement. Conclusion: Among the bilateral uveitis causes, it is crucial to remember Vogt-Koyanagi-Harada Syndrome (VKH), which occurs through bilateral uveitis, sometimes accompanied by retinal detachment, in association with hypochromic skin lesions, sensorineural hearing loss, headache and aseptic meningitis2 . VKH results from an autoimmune lesion in the melanocytes3 . Treatment should be done with topical corticosteroid, associated with cycloplegics and systemic corticosteroid therapy with long-term immunosuppression2.