Concurrent acute Vogt-Koyanagi-Harada disease in one eye and chronic disease in the fellow eye

BACKGROUND: Vogt-Koyanagi-Harada (VKH) disease is a granulomatous panuveitis, usually involving both eyes at the same time or within a few days or weeks. Acute and chronic diseases are characterized by distinct clinical features, treatment modalities, and visual outcomes. We report an atypical case of probable VKH disease, with features of acute disease in one eye and chronic disease in the fellow eye. FINDINGS: A 53-year-old female presented with exudative retinal detachment associated with mild vitritis in the right eye and anterior uveitis, vitritis, and sunset-glow fundus in the left eye. Based on clinical findings and results of multimodal imaging including fundus photography, spectral-domain optical coherence tomography, fluorescein angiography, indocyanine green angiography, and B-scan ultrasonography, a diagnosis of acute VKH disease in the right eye and chronic VKH disease in the left eye was made. The patient received systemic corticosteroids and mycophenolate mofetil. After a 15-month follow-up, the right fundus eye was normal, and there was a sunset-glow fundus in the left eye. CONCLUSIONS: VKH disease may begin with asymptomatic unilateral ocular involvement. The patient may present only when the fellow eye is affected. A significant delay before involvement of the second eye leads to atypical features of acute disease in one eye and chronic disease in the other eye.