A case of vogt-koyanagi-harada disease with multiple recurrences of meningitis

Purpose : To report a rare case of Vogt-Koyanagi-Harada (VKH) disease with recurrent meningitis. Cases: A 16-year-old male presented with a 1-week history of conjunctival hyperemia and decreased vision in both eyes. He had been treated with the diagnosis of aseptic meningitis by a local neurologist one month before the presentation. Findings and Clinical Course: Ophthalmic examination showed iridocyclitis and optic disc hyperemia and swelling in both eyes. The diagnosis of incomplete VKH disease was made according to the additional examinations including fluorescein angiography, indocyanine green angiography, spectral domain optical coherence tomography, and cerebrospinal fluid examination. High-dose corticosteroid therapy was initiated and tapered, which led to the improvement of uveitis. However, two times of recurrent meningitis without iridocyclitis were observed while the corticosteroid was tapered. Then he was treated with pulsed corticosteroid therapy, which led to the remission of meningitis and uveitis. Conclusion: We assumed that one of the reasons for the recurrent meningitis without definite uveitis may be the rapid tapering of corticosteroid. Another reason may be that the amount of corticosteroid to suppress the inflammation may be larger for the meningitis than that for the uveitis in this VKH patient.