Vogt-Koyanagi-Harada (VKH) Syndrome Mimicking Bilateral Optic Neuritis.
Aashka Shah, Siddhartha Rao, Rajesh K Singh et al.
✦ AI-curated · Sources linked
Case in brief
A 36-year-old man developed progressive bilateral visual loss over 5 days, with papillitis on fundus examination. Brain MRI and CSF were normal, and serum NMO and MOG testing was negative. Treated initially for bilateral optic neuritis with intravenous methylprednisolone, he improved briefly before his vision worsened. MRI review suggested choroidal thickening; optical coherence tomography showed bilateral large neurosensory retinal detachments and intraretinal fluid, while fluorescein angiography demonstrated findings suggestive of VKH syndrome. After 3 cycles of plasma exchange, visual acuity improved to 6/6 in the right eye and 6/12 in the left.
What made this case unusual
VKH presented as bilateral seronegative optic neuritis without characteristic extraocular manifestations. The diagnostic clues were subtle choroidal thickening on MRI and retinal detachment with subretinal dye pooling on ocular imaging.
Diagnostic / clinical pearl
In bilateral seronegative optic neuritis, retinal and choroidal imaging findings can redirect the diagnosis toward VKH, even when extraocular features are absent.