Vogt-Koyanagi-Harada syndrome presenting with encephalopathy
A 57-year-old Iranian blind woman was admitted to the Al- Zahra Hospital Emergency Room in Isfahan, with complaints of fever and loss of consciousness. She was blind since 38 years ago because of the VKH syndrome. Her underlying syndrome was diagnosed in an ophthalmology center in London, UK, and she was on prednisolone for a while. Since then, she had no other symptoms. She also had no co-morbidities and had no head trauma during her life. Five days before referring to the hospital, she developed fever, headache, vomiting and intermittent disorientation to the time and place. At the day of admission, she gradually lost her consciousness. On arrival, her exam was: axillary temperature 39°Cand Glasgow Coma Scale 3/15. No sign of meningeal irritation was detected. Cerebrospinal fluid (CSF) analysis showed a mild increase in the protein level (60 mg/dL), while other parameters such as herpes simplex virus- polymerase chain reaction (HSV-PCR) were in normal limits. Brain magnetic resonance imaging (MRI) showed diffuse hypointensities in T1, hyperintensity in T2 and FLAIR techniques in the right temporal, both frontal and right parietal areas []. Other laboratory data were normal. The patient dramatically responded to systemic corticosteroid therapy and was discharged from the hospital with a good general condition.