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A 33-year-old otherwise healthy black woman presented to the emergency department for evaluation of blurry vision in both eyes. She had no relevant medical, family, or ocular history. There was no history of trauma or ocular surgery. One month prior to presentation, she had developed fevers, chills, and coughing. After several days, she had developed redness, pain, photophobia, and blurry vision in her left eye, and she had subsequently developed similar symptoms in her right eye. On presentation, her visual acuity was counting fingers OU. Intraocular pressures were 14 mm Hg OU. A slitlamp examination revealed mild conjunctival redness, 2+ anterior chamber cell, and flare in both eyes, as well as mild posterior synechiae. The cornea was clear without keratic precipitates, and there were no iris nodules. Pigment was present on the anterior lens capsule. A fundus examination demonstrated a moderate amount of vitreous cell, hyperemia and edema of the optic disc, and retinal detachments in both eyes (Figure). The detachments were inferior and shifted with the patient’s head position, suggesting serous detachments. Findings were similar bilaterally. A B-scan ultrasonographic test demonstrated bullous retinal detachments and diffusely thickened choroid.
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B. Quantiferon and rapid plasma reagin tests and chest radiography
The patient underwent a systemic workup, including chest radiography and serum testing for quantiferon gold and rapid plasma reagin (choice B) as well as treponemal antibodies, which were all unremarkable. Given the negative results of the workup, the patient’s presentation was consistent with probable Vogt-Koyanagi-Harada (VKH) disease.
Intravitreal triamcinolone injections (choice A) would not be the preferred next step because, while VKH disease is most likely, it is important to rule out infectious causes of panuveitis first, especially prior to local steroid treatments. Furthermore, systemic and not intravitreal steroids would be the preferred route.1
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Corresponding Author: Levi N. Kanu, MD, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, 1855 W Taylor St, Ste 1.145 (MC 648), Chicago, IL 60612 (email@example.com).
Published Online: September 5, 2019. doi:10.1001/jamaophthalmol.2019.3086
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
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