A 35-year-old woman with Vogt-Koyanagi-Harada (VKH) disease in the acute uveitic phase presents with bilateral exudative retinal detachments, disc hyperaemia, and meningismus. The investigation finding most characteristic of VKH during the acute phase is:
- A CSF examination showing pleocytosis (lymphocytic) in >80% of patients ✓
- B FFA showing multiple hyperfluorescent pinpoints at the RPE level with late pooling in the subretinal space (leopard skin pattern)
- C Serum ACE elevation confirming sarcoid aetiology
- D ANA positivity indicating autoimmune overlap
Correct answer: A. CSF examination showing pleocytosis (lymphocytic) in >80% of patients
Explanation
VKH is a T-cell mediated autoimmune granulomatous disease targeting melanocytes. In the acute uveitic phase, CSF pleocytosis (lymphocytic, with normal glucose and protein) occurs in >80% of patients and represents meningeal inflammation. The FFA shows multiple RPE-level pinpoints with late pooling ('tomato ketchup fundus' not leopard-skin; leopard-skin fundus is convalescent VKH), but CSF pleocytosis is pathognomonic in the acute phase. ACE elevation indicates sarcoidosis; ANA points to SLE.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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