Teaching NeuroImages: A case of Vogt-Koyanagi-Harada disease with bilateral retinal detachment

A 28-year-old East African man with progressive visual impairment and keratitis presented with new symptoms including headache, nausea, disequilibrium, tinnitus, and right leg paresthesias. MRI showed bilateral retinal detachments and diffuse leptomeningeal enhancement (figure). Lumbar puncture showed lymphocytic pleocytosis and elevated protein. His clinical picture was consistent with Vogt-Koyanagi-Harada (VKH) disease: an autoimmune inflammatory disorder with ocular, auditory, skin, and neurologic involvement.1 VKH disease is more common in Asian, Middle Eastern, and Hispanic populations.1 Treatment includes early high-dose corticosteroids with prolonged taper over months.1,2 His symptoms improved following high-dose methylprednisolone.