Vogt-Koyanagi-Harada Disease: Placoid-Like Presentation Associated with Serous Retinal Detachment

Abstract

Background: Vogt-Koyanagi-Harada disease is a multisystemic autoimmune disorder that is characterized by bilateral, chronic and granulomatous panuveitis. A placoid-like presentation of this condition is unusual and it can mimic other causes, such as syphilis. Complete evaluation and early treatment might improve visual outcome and decrease number of recurrent episodes. Case Presentation: We report a case of a 21 year-old female patient with progressive low visual acuity in both eyes and a placoid-like lesion associated with serous retinal detachment in the fundus exam. Optical coherence tomography showed a highly reflective subretinal membranous structure and subretinal fluid. Fluorescein angiography showed multiple areas of pinpoint leakage and optic disk staining. Other ancillary exams, such as serology and head/orbit computerized tomography were all normal. Cerebrospinal fluid revealed pleocytosis. The diagnosis of Vogt-Koyanagi-Harada was made and prompt treatment with high-dose systemic corticosteroid was started. The patient had a complete recovery of her visual acuity and has had no recurrence of inflammation so far. Conclusion: This article describes an unusual presentation of Vogt-Koyanagi-Harada disease evaluated with multimodal imaging and also highlights the benefits of the early diagnosis and prompt management.