0.14 Images of memorable cases: case 14

14. vogt-koyanagi-harada syndrome

The diagnostic clue in this patient is the telltale loss of hair coloring in the left eyebrow and eyelashes (poliosis) withcontiguous vitiligo. Additional features of this syndrome—all of which this patient had—include panuveitis, retinal detachment, pinpoint retinal leaks onfluorescein angiography, and evidence of auditory and central nervous system dysfunction, including aseptic meningitis. Decreased visual acuity is the rule.The cause is uncertain, but immune-mediated damage of melanocyte-containing tissue seems likely. Long-term corticosteroid therapy usually halts furtherocular damage and often improves vision.