Persistent Macular Edema in a Pediatric Vogt-Koyanagi-Harada Disease Patient: A Case Report

Vogt-Koyanagi-Harada disease (VKHD) is a rare multisystemic granulomatous disorder that mainly affects the central nervous system, eyes, inner ears, and skin, basically organs rich with melanocytes. This case report describes an 11-year-old Saudi Arabian female who presented with a six-month history of decrease in vision in both eyes associated with neck pain, right ankle pain, fatigability, and skin depigmentation. Her ophthalmological examination showed visual acuity of 6/30 oculus dextrus (OD) and 6/60 oculus sinister (OS), and her fundoscopic examination revealed vitreous opacity mainly in the right eye. Optical coherence tomography (OCT) demonstrated macular edema along with infiltration and optic edema. She was initially diagnosed as having posterior uveitis and treated with oral prednisone and steroid eye drops. A month later, her ophthalmological examination revealed a rebound of macular edema. Dosages of steroid and adalimumab injection were raised, and azathioprine was added. Her left macular edema was not resolved; therefore, an aflibercept injection was added. A differential diagnosis of VKHD needs to be considered. Any patient who presents with posterior uveitis should be screened for VKHD. Physicians and ophthalmologists need to be more aware of VKHD, as it can cause serious complications.