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TitleA challenging case of presumptive ocular tuberculosis with Vogt-Koyagani-Harada disease
PurposeTo present a seemingly clear-cut case of Vogt-Koyanagi Harada Disease (VKH) whose response to treatment was affected by a concomitant presumptive ocular tuberculosis.
MethodsA 69 year old Filipino female presented with a 2 week history of eye redness and sudden severe blurring of vision in both eyes with associated watery eye discharge, headache, tinnitus and vomiting. Patient complained of further worsening in vision 4 days after she was started on oral dexamethasone 1.5mg thrice daily prompting consult at our institution.
ResultsVisual acuity was counting fingers at 3 feet in both eyes. The anterior chamber was quiet. Bullous elevations of the retina at superior, inferior arcade and macula with whitish plaque-like lesions were noted and confirmed on Optical Coherence Tomography (OCT). Papillitis, retinal vasculitis, retinal pigment epithelitis and choroiditis seen on fluorescein angiography (FA). Initial impression was Vogt-Koyonagi-Harada disease. Blood work-up prior to treatment revealed elevated C-Reactive Protein and Erythrocyte Sedimentation Rate . TB quantiferon test was positive. . Anti-Tuberculosis Treatment (ATT) was started with regression of subretinal fluid and improvement in visual acuity 4 weeks after. With residual papillitis, retinal vasculitis, retinal pigment epithelitis and choroiditis, systemic prednisone was added at 1mg/kg/day. With progression of VKH noted by poliosis and choroidal depigmentation, oral azathioprine was initiated 50mg twice daily.
ConclusionThis case illustrated the importance of ruling out presumptive ocular tuberculosis prior to initiating management for inflammatory uveitis.
Conflict of interestNo
Authors 1
Last nameOCAMPO
Initials of first name(s)VV
CityMakati City
Authors 2
Last nameLansangan
Initials of first name(s)VC
CityMakati City