Vogt-Koyanagi-Harada disease is a rare, multisystem, autoimmune disorder with numerous clinical manifestations, mediated through a T-helper 1 response against melanocytes in the eye, inner ear, central nervous system, hair and skin. We describe a 20-year-old British–Honduran man with recent worsening headache and photophobia, vomiting and visual blurring. On examination, his pupils reacted sluggishly and visual acuities were bilaterally reduced. Optical coherence tomography showed gross retinal swelling and neurosensory detachments. MR scan of the brain was normal, but cerebrospinal fluid showed a reactive picture with 258 ×109 lymphocytes./L (normal ≤5×109/L). Following treatment with immunosuppression (prednisolone, tacrolimus, mycophenolate mofetil, adalimumab), he made a full recovery. Clinicians should consider Vogt-Koyanagi-Harada disease in patients presenting with headache with acute profound visual loss. A prompt diagnosis and immunosuppressive therapy can lead to complete resolution.
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Contributors AS and SPM identified the patient and led the clinical work-up, including initiation of all investigations. SPM and SS were responsible for identifying suitable clinical images and formatting the figures. SS was responsible for ongoing clinical follow-up of the patient. DS was responsible for collating all the data available and drafting the manuscript. All authors were involved in critical revision of the article and final approval of the version submitted.
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned. Externally peer reviewed by Christian Lueck, Canberra, Australia.