Juvenile Vogt-Koyanagi-Harada Disease in Which Good Visual Prognosis Was Derived from Swift and Definitive Diagnosis

Abstract

We report an 8-year-old girl who manifested Vogt-Koyanagi-Harada (VKH) disease. At the first visit, conjunctival hyperemia, inflammation in the anterior chamber, serous retinal detachment, and papillitis were observed in both eyes. Fluorescein angiography (FA) revealed bilateral subretinal fluid and papillitis. Ocular computed tomography (OCT) showed subretinal fluid and choroidal hypertrophy underneath macula in both eyes. Cerebrospinal fluid examination indicated aseptic meningitis. Systemic data did not suggest the other systemic diseases. Therefore, she was diagnosed with incomplete VKH disease. After corticosteroid pulse therapy, oral prednisolone was administered for seven months. Eighteen days after the induction of the treatments, inflammation in the anterior chamber and serous retinal detachment of both eyes disappeared completely. For seven months after the induction of the treatments, she had no relapses of any symptoms. Cerebrospinal fluid examination and FA for children are difficult to conduct, since it is difficult to get informed consent of these examinations from their parents. However, those thorough examinations enable us to make a swift and definitive diagnosis of VKH disease, thus assuring good visual prognosis. We have to bear in mind that juvenile VKH disease is very rare, yet when it occurs, ophthalmologic examinations help us diagnose and treat it.

Figure 1

(a) Color photographs of the fundi at the first visit: serous retinal detachment of posterior pole and papillitis were observed in both eyes. (b) Ocular coherent tomography (OCT) images of the fundi at the first visit: OCT image revealed serous retinal detachment in both eyes. (c) Fluorescein angiography of the fundi at the first visit: fluorescein angiography revealed serous retinal detachment of posterior pole and papillitis in both eyes.

Figure 2

(a) Color photographs of the fundi at three weeks after the start of the treatments: in both eyes, serous retinal detachment of posterior pole and papillitis disappeared. (b) OCT images of the fundi at three weeks after the start of the treatments: in both eyes, serous retinal detachment of posterior pole disappeared and the thickness of choroid of posterior pole increased.

Figure 3

(a) Color photographs of the fundi at four months after the start of the treatments: both eyes showed sunset glow fundi. (b) OCT images of the fundi at four months after the start of the treatments: there was no serous retinal detachment of posterior pole and the thickness of choroid decreased in each eye.