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.