Typical features of Vogt Koyanagi Harada disease (VKH disease)
It is an idiopathic, bilateral, chronic panuveitis more commonly occurring in Asian, Hispanic, and Native American populations that progresses over phases (prodromal, uveitic, convalescent, and chronic/recurrent). The prodromal phase may include an aseptic meningitis-like presentation (lymphocytic pleocytosis on lumbar puncture) and other neurologic deficits including auditory symptoms. The acute uveitic phase results in an exudative retinal detachment in over 80% of cases. The uveitic phase is followed by a convalescent period in which the fundus may demonstrate a characteristic “sunset glow” appearance resulting from choroid depigmentation. Skin changes (vitiligo, poliosis, and alopecia) do not typically appear until this convalescent phase; thus cutaneous findings cannot be relied upon to make an early diagnosis. VKH must be distinguished from sympathetic ophthalmia, which is a bilateral, autoimmune uveitis resulting from trauma to one eye.
