Complete Vogt-Koyanagi-Harada Disease and Holmes-Adie Syndrome: Case Report

Figures & data

Figure 1. Fundus photographs of both eyes on admission, showing vitreous opacity and serous retinal detachment in right eye, and hyperemic optic disk and serous retinal detachment in left eye.

Figure 2. Denervation supersensivity test, after thirty minutes of one drop 0.125% pilocarpine, showed left pupil constriction from 6.7 to 4.1 mm.

Table 1. Ocular manifestations.

Author	Gender	Age (years)	Tonic pupil	Uveitis	Uveitic phase	Recurrent phase	Pilocarpine test
Brouzas et al. 19971	Female	32	Bilateral	Bilateral	Anterior chamber cells 2+, flare, vitritis 1+, papillitis, small retinal detachment	Anterior chamber cells 4+, flare	Not reported
Kim et al. 20012	Female	38	Bilateral	Bilateral	Iridocyclitis, papillitis, macular edema	Not reported	Positive
Narang et al. 20103	Female	28	Bilateral	Bilateral	Anterior chamber cells 2+, flare 2+, vitritis 1+, retinal detachment	Anterior chamber cells 2+, vitritis 1+	Positive
Garza et al.^a	Female	37	Left eye	Bilateral	Anterior chamber cells 3+, retinal detachment	No recurrence	Positive

Patient 1 had uveitic and recurrence phase but pilocarpine test wasn't reported so diagnosis of Holmes Adie syndrome can't be supported. Patient 2 has no recurrence phase reported. Patient 3 recurrence phase has vitreous inflammation who is unusual in this phase. Our patient it's the only who has complete and characteristic information of both diseases.

Table 2. Systemic manifestations.

Author	Prodromal phase	Convalescent phase	Deep tendon reflexes	Light-near dissociation	Other findings
Brouzas et al. 19978	Headache, nuchal rigidity, low-grade fever	Vitiligo, “sunset-glow” fundus	Not reported	Present	Corneal epithelial loss and anesthesia
Kim et al. 20017	Headache with nausea, vomiting, and myalgia	Alopecia, poliosis, vitiligo	Present	Present
Narang et al. 20109	None	None	Not reported	Present
Garza et al. 2012	Tinnitus	Alopecia, vitiligo, sunset glow fundus; nummular chorioretinal depigmented scars	Absent	Present

Patient 1 had complete Vogt-Koyanagi-Harada disease according to criteria. Patient 2 had incomplete Vogt-Koyanagi-Harada disease (she presented integumentary findings but no neurological or auditory involvement). Patient 3 had probable Vogt-Koyanagi-Harada disease (it was not reported if the patient had neurological, auditory, or integumentary findings). Our patient has complete Vogt-Koyanagi-Harada disease.

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