Concurrent bilateral posterior scleritis and Vogt-Koyanagi-Harada disease in a patient with positive rheumatoid factor

We examined a 67-year-old man who complained of headache and pain and decreased visual acuity in both eyes. The patient had dilated conjunctival and episcleral vessels, intracameral cells, shallow anterior chambers, hyperemic swollen optic disks, exudative retinal detachment and choroidal detachment. Fluorescein angiography showed leakage of dye from the optic disks and choroid into the subretinal space. Scleral thickening was found by computed tomography. These abnormal findings disappeared within 1 week after treatment with a systemic corticosteroid. Laboratory test results showed positive rheumatoid factor. Sunset glow fundi and vitiligo developed a few months after the treatment. We believe that concurrent bilateral posterior scleritis, Vogt-Koyanagi-Harada disease and positive rheumatoid factor, as demonstrated in our patient, may be rare.