Mantovani Alessandro, Resta Anna, Herbort Carl P, Abu El Asrar Ahmed, Kawaguchi Tatsushi, Mochizuki Manabu, Okada Annabelle A, Rao Narsing A
Unit of Ophthalmology, Ospedale Valduce, Como, Italy.
Int Ophthalmol. 2007 Apr-Jun;27(2-3):105-15. doi: 10.1007/s10792-007-9052-y. Epub 2007 May 5.
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.
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.
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.
典型的原田病（VKH）在起病时具有易于识别的体征，诊断并不困难。对于非急性起病、就诊较晚或体征不完整的病例，评估则更为困难，诊断也可能存在困难。我们在此呈现一例符合VKH病的双侧肉芽肿性葡萄膜炎病例，以便多位专家就确诊或排除诊断的最恰当方法及其病例处理方法发表意见。
一名17岁女性患者因流感样疾病伴不适、发热和头痛后出现双眼视力模糊而咨询眼科医生。诊断为双侧前葡萄膜炎伴右侧视乳头炎，患者双眼出现急性近视。荧光素血管造影显示右侧视盘高荧光伴晚期渗漏以及左侧视盘轻度高荧光。患者接受了为期一周的口服皮质类固醇治疗，随后每周两次注射苯替兰。由于病情无明显改善，六周后患者被转至一家专科中心进行全面检查。
专家们将描述确诊或排除VKH诊断的诊断检查、研究性试验和鉴别诊断以及该病例的处理。
