Multimodal Imaging of an Atypical Onset Acute Vogt Kayanagi Harada Disease: A Case Report

Author: Ahmet Kaderli (Turkey)

Co-authors: Sema Tamer Kaderli, Aylin Karalezli

Purpose

To present a case with an atypical onset of Vogt Kayanagi Harada Disease.

Setting/Venue

Muğla Sıtkı Koçman University Hospital.

Methods

A 54 years old female was reffered to our hospital with reduced visual acuity in her left eye and severe headache. In her detailed ophthalmologic examination best corrected visual acuity was 20/20 in her right eye and 20/200 in the left eye. Nongranulomatous keratic precipitates, +2 cells in anterior chamber, posterior synechia were detected in the left eye in the anterior segment. Fundus examination in the left eye showed vitritis, disc edema and serous retinal detachment. Biomicroscopic view, wide-field fundus image, fundus fluorescein angiography (FFA) and Enhanced deep imaging optic coherence tomography (EDI-OCT) images are given in Figure 1. In her unaffected right eye, she had pigmented scars which were similar a scar of Toxoplasma retinochoroiditis. A widespread uveitis screening was performed. Toxoplasma gondii Ig M and Ig G were positive. Oral trimethoprim-sulfamethoxazole and clarithromycin treatment was performed and two days after antibiotics, oral prednisolone (1mg/kg) treatment was added with topical prednisolon asetat and tropicamid.

Results

1 week later she had reduced visual acuity in her right eye. In fundus examination, Optic disc edema and serous retinal detachment in the papillomacular bundle were detected. Fundus image, EDI-OCT, retinal nerve fiber layer (RNFL) thickness and indocyanine green angiography (ICG) of both eyes at first week of treatment were given in Figure 2. Sensoryneural deafness in audiometric test and increased lympocytes in lumber puncture were determined. Toxoplasma Ig avidity test was resulted with low affinity. She was diagnosed with Acute Vogt Kayanagi Harada disease. Intravenous methylprednisolon asetate 1gr per day was performed for 7 days. Subretinal serous detachment and retina pigment epithelium ondulations was regressed and the thickness in choroidea was decreased in EDI-OCT. Intravenous corticosteroid therapy was switched to oral prednisolone (1mg/kg) with oral cyclosporine (50mg/day) after that. In the first month of treatment her visual acuity was 20/20 ou and serous detachment was regressed in both eyes.(Figure 3)

Conlusions

Clinical examination is often more important than laboratory tests. It is crucial to initiate early intravenous corticosteroid treatment in acute VKH to prevent the transition to the chronic stage. Immunosuppressant therapy should be added in addition to maintenance oral corticosteroid treatment.

Financial Disclosure

None.