Occult invasive fungal sinusitis in a patient with acute Vogt-Koyanagi-Harada Disease (VKHD).

Abstract

Purpose: We present a case of the development of invasive fungal sinusitis in a patient with acute Vogt-Koyanagi-Harada Disease (VKHD).

Methods: Observational case report.

Results: A 39-year-old African American female presented with acute vision loss in both eyes and reported pain around her left eye. Examination revealed a bilateral posterior uveitis with significant macular edema and subretinal fluid in both eyes. Systemic and ocular findings were consistent with complete VKHD and the patient was put on oral glucocorticoids. At follow-up 2 weeks later, blood sugars were found to be severely elevated, and the patient was hospitalized. During hospitalization, the patient was taken off steroids. At follow-up, the uveitis appeared quiescent, but vision was still poor in the left eye. The patient reported a continued sense of pressure and now numbness around the left eye. An MRI revealed occult invasive fungal sinusitis and the patient was hospitalized for treatment. The patient recovered after surgery for debridement of the sinuses and several weeks of treatment with amphotericin B. At the most recent follow up, 18 months following the initial visit, the patient's visual acuity was 20/20 OD and 20/50 with eccentric viewing OS.

Conclusion: Many forms of uveitis such as acute VKHD require use of oral glucocorticoids. However, proper use of glucocorticoids involves patient counseling on potential side-effects and the prescribing physician to identify potential life-threatening complications. In this case, failure to identify either the severely elevated blood sugars or occult fungal sinusitis could have resulted in significant patient morbidity or even mortality.