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Melanin-laden macrophages in the CSF to diagnose Vogt-Koyanagi-Harada simulating ocular syphilis
Leo A Kim1, Rahul N Khurana, Jignesh G Parikh
1Doheny Eye Institute, Department of Ophthalmology, University of Southern California, Los Angeles, California 90033, USA.
Purpose:
To describe a case of Vogt-Koyanagi-Harada (VKH) disease initially presenting as ocular syphilis.
Methods:
A 51-year-old woman presented with counting fingers vision in both eyes. She underwent a complete ophthalmic examination, serological testing, fluorescein angiography, and CSF analysis.
Results:
Serological testing revealed positive titers for syphilis. Fluorescein angiography demonstrated findings suggesting VKH. CSF cytology showed macrophages containing melanin granules consistent with VKH. Subsequent treatment with corticosteroids and cyclosporine resulted in significant improvement of vision.
Conclusion:
The presence of melanin-laden macrophages within the CSF allows for the differentiation of VKH from ocular syphilis.
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