A 30-year-old male patient presents with bilateral granulomatous panuveitis, depigmented skin patches (vitiligo-like poliosis of the lashes), hearing loss, meningismus, and CSF pleocytosis. The most likely diagnosis and causative mechanism are:
- A Behcet's disease; immune complex vasculitis
- B Vogt-Koyanagi-Harada (VKH) disease; T-lymphocyte-mediated autoimmunity against melanocyte antigens ✓
- C Sympathetic ophthalmia; CD4+ T-cell response to uveal antigens
- D Sarcoid panuveitis; non-caseating granulomatous inflammation
Explanation
Vogt-Koyanagi-Harada (VKH) disease is a bilateral granulomatous panuveitis with extraocular manifestations targeting melanocyte-rich tissues. The four stages are: prodromal (meningism, CSF pleocytosis, tinnitus, hearing loss), uveitic (bilateral posterior uveitis with exudative retinal detachment, disc edema), convalescent (poliosis—white lashes/hair, vitiligo-like skin, Sugiura sign—perilimbal depigmentation), and chronic recurrent. It is an autoimmune attack against melanocyte-associated antigens by CD4+ T-helper cells, strongly associated with HLA-DR4. Treatment is high-dose systemic corticosteroids followed by long-term immunosuppression.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.