A perplexing case of bilateral Vogt-Koyanagi-Harada syndrome

Vogt–Koyanagi–Harada (VKH) disease presents as a bilateral granulomatous panuveitis with systemic manifestations. We report a 60-year-old female who presented with features suggestive of VKH and was treated with steroids and immunosuppression. Although thorough investigation ruled out tuberculosis (TB) at presentation, she developed neurotuberculosis 2 months after initiating treatment. The primary diagnosis of VKH was hence revisited. Since both VKH and TB uveitis can present as chronic granulomatous panuveitis, it is important to differentiate between them. Once started on immunosuppression, patients should be kept on close follow-up for early detection of development of infections or reactivation of latent TB.