, Volume 27, Issue 2-3, pp 105-115
Date: 05 May 2007

Work-up, diagnosis and management of acute Vogt-Koyanagi-Harada disease

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Abstract

Purpose

In its typical form and when seen at onset, Vogt-Koyanagi-Harada (VKH) is characterized by easily recognizable signs that allow diagnosis without difficulty. In cases that do not have acute onset, that are seen at a later stage or that do not show the complete set of signs, appraisal is more difficult and diagnosis may cause difficulties. We present here a case of bilateral granulomatous uveitis compatible with VKH disease in order to allow several experts to give their opinion on the most appropriate manner to confirm or reject the diagnosis and their approach to the management of the case.

Case presentation

A 17-year-old female patient consulted her ophthalmologist for blurred vision OU following an episode of a flu-like disease with malaise, fever and headaches. A bilateral anterior granulomatous uveitis with a right papillitis was diagnosed and the patient presented with a bilateral acute myopization. Fluorescein angiography showed right disc hyperfluorescence with late leakage and slight left disc hyperfluorescence. The patient was given a course of one week of peroral corticosteroid therapy followed by an intramuscular injection of Bentelan® twice weekly. In the absence of significant improvement the patient was sent six weeks later to a specialized center where a complete work-up was performed.

Expert opinion

The diagnostic work-up, investigational tests, and differential diagnosis to confirm or reject the diagnosis of VKH as well as the management of the case will be described by the experts.

This section is devoted to updates in controversial or hot clinical or scientific issues or to the publication of opinions in the management of practical clinical situations.
In “Perspectives” controversial or hot topics are addressed by leaders or experts in a field either by giving their perspective on the topic, or by revisiting the appraisal of a topic. Usually more than one author is invited.
In “Expert Opinions” a clinical case is presented and different experts in the field are solicited to express their expert opinion in the management of a given clinical situation.