A Woman With Headaches And Blurred Vision

A 47-year-old woman with a history of migraines presented with a 10-day history of neck pain and bilateral blurred vision. Neurological examination showed truncal ataxia and terminal neck stiffness. Fundal photographs and fluorescein fundal angiogram revealed signs consistent with Vogt–Koyanagi–Harada disease (VKHD), a rare autoimmune disorder affecting melanocytes. VKHD can cause uveitis, neurological and auditory symptoms, and cutaneous findings like alopecia and vitiligo. The patient was treated with 60 mg of prednisolone daily, resulting in reduced retinal striae and subretinal exudates, and resolution of symptoms within 12 days. She was maintained on low-dose prednisolone and methotrexate, achieving 6/6 vision in both eyes without further headaches after 3 months.