case_images: PMC6489034_01
case_images: Ophthalmological examinations in the acute phase of Vogt-Koyanagi-Harada disease (VKHD) at the age of 43 (a-h), the chronic phase of VKHD at the age of 47 (i, j), and at the onset of sarcoidosis at the age of 50 (k, l). Color retinal photographs of the right (a) and left eyes (b) showing swollen and hyperemic optic discs (arrows). Optical coherence tomography of the right (c) and left eyes (d) showing multifocal serous retinal detachments (arrowheads). Ultrasonic B-mode examination of the right (e) and left eyes (f) showing diffuse thickening of the choroid with low to medium reflectivity (arrowheads). The arrows in e and f indicate the optic nerves. Fundus fluorescein angiography of the right (g) and left eyes (h) showing optic disc leakage and numerous hyperfluorescent pinpoints of leakage. Color retinal photographs of the right (i) and left eyes (j) showing "sunset glow fundus." Color retinal photographs of the right (k) and left eyes (l) showing Dalen-Fuchs atrophic nodules in the retinal periphery (arrows), which are typical of VKHD.
case_images: cop-0010-0032-g01.jpg
case_images: PMC6489034_01_cop-0010-0032-g01.jpg
case_images: F1
case_images: Fundus fluorescein angiography revealed optic disc leakage and numerous hyperfluorescent pinpoints of leakage (Fig. 1). Her fundi showed depigmentation and changed to a reddish glow, which is called "sunset glow fundus" (Fig. 1i, j).
case_images: a Chest X-ray at the age of 50 showing no notable findings, including bilateral hilar lymphadenopathy, which is typical of sarcoidosis. b-d Chest CT showing enlargement of some mediastinal lymph nodes (arrowheads). e Histopathology of subcutaneous nodule in the right arm showing multinucleated giant cells. Scale bar = 50 microm.
case_images: cop-0010-0032-g02.jpg
case_images: PMC6489034_01_cop-0010-0032-g02.jpg
case_images: F2
case_images: However, chest CT showed enlargement of some mediastinal lymph nodes (Fig. 2a-d). Histopathological analysis of the subcutaneous tumor in the right arm showed multinucleated giant cells (Fig. 2e).
case_images: Clinical course in this case. AC, anterior chamber; ACE, angiotensin-converting enzyme; mPSL, methylprednisolone; PSL, prednisolone; sIL-2R, soluble interleukin-2 receptor; VKHD, Vogt-Koyanagi-Harada disease.
case_images: cop-0010-0032-g03.jpg
case_images: PMC6489034_01_cop-0010-0032-g03.jpg
case_images: F3
case_images: Although serum ACE and lysozyme levels decreased to 12.4 U/L and 5.5 microg/mL, 3 months after introduction of steroid therapy, dysesthesia and sensory disturbance in the left half of her face and extremities had not changed at the time of this report (Fig. 3).