A challenging case of presumptive ocular tuberculosis with Vogt-Koyagani-Harada disease
Purpose
To present a seemingly clear-cut case of Vogt-Koyanagi Harada Disease (VKH) whose response to treatment was affected by a concomitant presumptive ocular tuberculosis.
Methods
A 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.
Results
Visual 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.
Conclusion
This case illustrated the importance of ruling out presumptive ocular tuberculosis prior to initiating management for inflammatory uveitis.
Conflict of interest
No
Authors 1
Last name
OCAMPO
Initials of first name(s)
VV
Department
Ophthalmology
City
Makati City
Country
Philippines
Authors 2
Last name
Lansangan
Initials of first name(s)
VC
Department
Ophthalmology
City
Makati City
Country
Philippines
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