Probable Vogt–Koyanagi–Harada disease with initial unilateral ocular manifestation in a hepatitis C carrier

Vogt–Koyanagi–Harada (VKH) disease is a systemic disorder with typical bilateral granulomatous panuveitis and variable degrees of systemic features, including meningismus, vitiligo, poliosis, and dysacusis. The exact pathogenesis remains unknown, and a theory of autoimmune response against certain antigenic component of melanocytes has been suggested [1]. Diagnosis is mainly based on clinical findings. Revised diagnostic criteria for VKH disease stressed the importance of the presence of bilateral uveitis [2]. Most patients do present with bilateral ocular involvement, where onset in the second eye might show 2 to 3 weeks of delay than the first eye. However, several cases of unilateral disease have also been reported after long-term follow-up [3]. Nowadays, the mainstay of treatment would be high dose systemic corticosteroid, although steroid-sparing agents should be considered in patients unable to tolerate steroid or in those who have developed steroid dependence [4].