Early manifestation of Vogt-Koyanagi-Harada disease as unilateral posterior scleritis

Purpose: To describe a patient with an initial diagnosis of unilateral posterior scleritis who developed bilateral Vogt-Koyanagi-Harada (VKH) disease 12 months later. Case: A 38-year-old woman was diagnosed with posterior scleritis in her right eye at successive examinations. The left eye showed no signs of ocular inflammation. Observations: Her right eye developed a second attack of posterior scleritis 3 months after the initial diagnosis. Twelve months after the first incident, granulomatous uveitis and sunset glow fundus were observed in both eyes. At the same time, lymphocytosis was found in the cerebrospinal fluid, and she was HLA DR-4-positive. In addition, poliosis was noted. Conclusions: The final diagnosis was primarily VKH disease with presenting signs and symptoms of unilateral posterior scleritis. We therefore recommend that when following a patient with posterior scleritis include VKH disease in the differential diagnosis. (C) 2002 Japanese Ophthalmological Society.