Vogt-Koyanagi-Harada Syndrome: Acute Presentation, Fundus Appearance

This 33 year old Latino woman developed acute onset of visual blurring, headache, and sensitivity to lights. Her visual acuity was 20/100 both eyes. She saw a neuro-ophthalmologist who discounted optic neuropathy and referred her for retinal evaluation. The fundus photographs show pockets of subretinal fluid (yellow arrows). The patient was referred to a neurologist for consideration of lumbar puncture expecting there to be inflammatory cells in the cerebrospinal fluid. The treatment was high dose oral prednisone to control the acute presentation with concomitant institution of mycophenolate mofetil to gradually suppress the autoimmune process and allow the prednisone to be slowly tapered.