Vogt-Koyanagi-Harada Syndrome: A Diagnostic Conundrum

Vogt-Koyanagi-Harada disease is a vision-threatening autoimmune disease mediated by adaptive immune responses via T helper (Th) 1 and Th17 cell activation. The disease often starts with a flu-like illness followed by eye pain, headache, and dizziness later evolving into vision loss bilaterally. Other symptoms may include vitiligo and hearing loss. Diagnostic criteria include exclusion of other eye diseases, no history of recent penetrating eye trauma or surgery, bilateral ocular involvement with evidence of diffuse choroiditis, auditory and neurological findings (tinnitus and meningismus), and skin findings including depigmentation or alopecia. Retinal examination reveals bilateral uveitis with choroidal thickening (which may be seen as a sub-retinal fluid collection or serous retinal detachment). Treatment includes corticosteroid therapy with the addition of biological and immunosuppressive medications as needed to suppress the disease activity and ensure symptomatic improvement.