Case Report
A 27-year-old male with no significant past medical history presented with a two-week history of intermittent unilateral headache, bilateral eye pain with photophobia, and phonophobia, followed by tinnitus and blurry vision, which ultimately progressed to total bilateral vision loss. His initial physical exam was unremarkable including vitals, except for total bilateral visual loss with preserved light perception. An ophthalmologic exam revealed normal intraocular pressure and panuveitis with serous retinal detachments bilaterally.
The patient was admitted for further evaluation. Infectious work-up revealed positive COVID-19 PCR. Other infectious and metabolic panels were unremarkable. Cerebrospinal fluids studies (CSF), VDRL, FTA, QuantiFERON gold, flow cytometry, cytology, and cultures were all negative, except for moderate pleocytosis with lymphocytes predominance and elevated CSF protein. Cytology was also negative for malignancy. Computed tomography, B-scan, and magnetic resonance imaging (MRI) showed bilateral retinal detachment with no optic nerve involvement (Figure 1). Fundus Fluorescein angiography (FFA)/indocyanine green (ICG) of the bilateral retinal vessels revealed mottled hyperfluorescence and hypofluerescence as well as fundus auto fluorescence bilaterally associated with retinal pigment epithelium detachment consistent with VKH (Figure 2).
The patient was subsequently diagnosed with VKH. He was treated with high dose prednisone and was then discharged on a prednisone taper and methotrexate. Sixteen weeks later, the patient had a visual recovery to 20/60 on the left eye and 20/80 on the right eye, and his symptoms have since resolved.