Vogt-Koyanagi-Harada syndrome presenting with encephalopathy
An Isfahanian, 57-year-old blind woman presented to the Al-Zahra Hospital Emergency Room, suffering with fever and loss of consciousness. She had become blind 48 years ago due to the VKH syndrome. Her underlying syndrome was diagnosed in an ophthalmology center in London, and she had been taking prednisolone for a period of time. She had no other symptoms during these years. Five days before referring to the hospital, she had been experiencing fever, headache, vomiting and intermittent disorientation to time and place. At the day of admission, she gradually lost her consciousness. On examination the axillary temperature was 39°C and Glasgow Consciousness Score was 3/15. No signs of meningeal irritation were detected. Cerebrospinal fluid (CSF) analysis showed a mild increase of protein (60 mg/dL), and other parameters such as herpes simplex virus - polymeaerase chain reaction (HSV-PCR) were normal. Brain magnetic resonance imaging (MRI) showed diffuse T2 and FLAIR hyperintensity in the right temporal, both frontal and right parietal lobes that were hyposignal in T1 []. Other laboratory data were normal. The patient dramatically responded to systemic corticosteroid therapy and was discharged from the hospital with good general condition.