Disclosures: Nabela Enam, MD: Nothing to disclose

Case Description: This physically active patient with a past medical history of diabetes, coronary artery disease, and high-grade colonic dysplasia was initially hospitalized for pneumonia. His course was complicated by muscle atrophy, new onset nausea, vomiting, anorexia, headaches, and blurry vision. Work-up was negative and his symptoms improved following a rapid steroid taper. Shortly thereafter, he was readmitted for acute bilateral, blindness, cranial nerve palsy, panuveitis, and gastrointestinal involvement. An extensive work-up, including temporal artery biopsy and lumbar puncture, was unremarkable. His blindness was attributed to an autoimmune process and he was diagnosed with Vogt-Koyanagi-Harada (VKH) disease. Higher dose steroids resulted in symptomatic improvement.

Setting: Inpatient Rehabilitation Facility

Patient: A 65-year-old-male

Assessment/Results: On admission to acute rehabilitation, physical exam revealed bilateral cranial nerve three and six palsies and diffuse atrophy. Electrodiagnostic studies revealed diffuse sensory and motor demyelination with axonal loss in all extremities. There was also evidence of ongoing re-innervation. These results suggested a monophasic autoimmune neuropathy, possibly triggered by his recent pneumonia. The patient participated in therapy with continued improvement.

Discussion: VKH is an uncommon multi-system autoimmune disease caused by inflammation of melanocytes. It may initially present with headache, dizziness, nausea, vomiting, hearing loss, and less commonly cranial nerve palsies. Patients may later develop visual loss, pain, and swelling. Recovery is maximized by an early, aggressive, and prolonged course of steroids or immunomodulatory therapy in refractory cases.

Conclusion: Management of VKH requires an interdisciplinary team given the extensive multi-system involvement. The physiatrist’s role in optimizing functional outcomes with targeted therapy to minimize deficits and accelerate recovery is essential.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/vogt-koyanagi-harada-syndrome-in-an-adult-with-bilateral-vision-loss-a-case-report/