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Images of Memorable Cases: Case 14

Module by: Herbert L. Fred, MD, Hendrik A. van Dijk

Case_14-pres1-1.jpg

This 27-year-old Hispanic man presented with headache, tinnitus, and blurred vision of several weeks’ duration.

14. Vogt-Koyanagi-Harada syndrome

The diagnostic clue in this patient is the telltale loss of hair coloring in the left eyebrow and eyelashes (poliosis) with contiguous vitiligo. Additional features of this syndrome—all of which this patient had—include panuveitis, retinal detachment, pinpoint retinal leaks on fluorescein angiography, and evidence of auditory and central nervous system dysfunction, including aseptic meningitis. Decreased visual acuity is the rule. The cause is uncertain, but immune-mediated damage of melanocyte-containing tissue seems likely. Long-term corticosteroid therapy usually halts further ocular damage and often improves vision.

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