Vogt KoyanagiHarada Disease

Vogt-Koyanagi-Harada (VKH), also known as an uveomeningoencephalitis, is characterized by a chronic granulomatous panuveitis affecting both of the eyes. Patients typically present with acute loss of vision and pain in one or both eyes. Inflammation can affect virtually any of the ocular structures. Early findings may include optic disc swelling, thickening of the posterior choroid with elevation of the peripapillary retinochoroidal layer, and exudative retinal detachments. Later findings may include extensive depigmentation of the fundus (called "sunset glow" fundus). The typical age of onset is 30 to 40 years of age; women are affected more frequently than men; and the disease occurs more frequently in pigmented ethnic groups.

Other head and neck symptoms may consist of tinnitus, vertigo, scalp sensitivity, and dysacousia. These symptoms, together with meningismus and headache, most frequently characterize the prodromal stage of VKH. Prodromal findings may also include low-grade fever, nausea, and vomiting. Cerebrospinal fluid analysis often reveals a lymphocytic pleo-cytosis indicative of meningeal inflammation. Other stages include the acute uveitic stage, the chronic stage when depigmentation occurs, and the chronic recurrent stage, characterized by mild panuveitis and recurrent episodes of anterior uveitis. Chronic stage depigmentation may also include perilimbal vitiligo ("Sugiura sign"); vitiligo symmetrically involving the face, hair, eyelids, and trunk; and poliosis (depigmentation of the eyelashes) (15).

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