Asymmetric and incomplete vogt Koyanagi – Harada syndrome: Patient's perceptive dilemma

Abstract

Vogt–Koyanagi–Harada (VKH) is a rare autoimmune multisystem disease. Here, we report a case of VKH with asymmetric involvement and the importance of patient counselling and a comprehensive approach. A 45-year-old female patient went to tertiary care with left-sided headache and sudden diminution of vision in the left eye (LE) since 1 day. She was advised lumbar puncture but became apprehensive and came to us with visual acuity (VA) 6/6 in the right eye (RE) and HMCF PL+, PR accurate in LE. LE showed lid oedema, mild conjunctival congestion, vitritis, disc oedema, choroidal detachment and exudative retinal detachment (ERD) involving the macula. The patient was suspected to have incomplete VKH. Neurologic, Ear, Nose, Throat (ENT) and dermatology consults were taken. The patient was counselled about the systemic issue, the possibility of other eye involvement later and the need for a team-based approach. The patient was started on steroids. At 6 months, VA in RE - 6/36 and in LE - 6/60, RE showed a pocket of ERD. Asymmetric involvement of both eyes is an infrequent presentation highlighting the necessity of a comprehensive approach along with diligent patient counselling for allaying fears.