Reflections on a case of Vogt-Koyanagi-Harada syndrome first diagnosed in internal medicine: a case report.

BACKGROUND

A case of Vogt-Koyanagi-Harada syndrome (VKH) first diagnosed with encephalitis was reported and it bring us the clinical reflection.

CASE DESCRIPTION

A 73-year-old Chinese woman was first diagnosed in the department of neurology with headache, nausea, vomiting, and elevated body temperature. Cerebrospinal fluid (CSF) assays showed significant increases in leukocytes and Cerebrospinal fluid total protein (CS-TP). Gradually, symptoms appeared in the eyes including decreased vision, keratic precipitates (KP) (+++), iris local posterior adhesion, vitreous opacity, and optic disc congestion edema. The fundus fluorescence examination showed optic disc hyperfluorescence with both eyes exudative retinal detachment. Type-B ultrasonography of obit showed a large number of flocculent opacities in the vitreous and retinal edema. Optical coherence tomography (OCT) showed that significant edema was evident in the macular area and papillary, and there were wavy changes in the retinal pigment epithelium layer. Review of the clinical, photographic, fundus fluorescence angiography (FFA) data of the patient suggested a clinical diagnosis of VKH.

CONCLUSIONS

VKH is an autoimmune disease involving many systems. It has specific systemic symptoms, such as tinnitus, dizziness, headache, nausea, skin injury and so on. But Neurological and auditory manifestations usually precede the involvement of other sites especially in the neurological manifestations. So we should pay attention to the diversity of clinical manifestations, so as to avoid delaying treatment or even misdiagnosis in clinical diagnosis and treatment.