BACKGROUND: Vogt-Koyanagi-Harada (VKH) disease is a rare autoimmune disorder targeting melanocyte-rich tissues that often presents with bilateral ocular inflammation and multisystem involvement. Early manifestations, such as headache and optic disc edema, can mimic other conditions, leading to diagnostic delays. Clinician awareness is essential, particularly in high-risk populations, to ensure timely intervention.

CASE REPORT: We report the case of a 55-year-old Indian man who presented with a 20-day history of progressive bilateral visual loss, headache, and hearing impairment. Ophthalmologic examination revealed hand motion vision in both eyes, anterior chamber inflammation, disc edema, and serous retinal detachments. Spectral-domain optical coherence tomography confirmed neurosensory detachment and disc edema, whereas B-scan ultrasonography demonstrated pronounced choroidal thickening. Brain and orbital magnetic resonance imaging revealed bilateral focal nodular choroidal lesions. Laboratory investigations excluded infectious, malignant, and systemic inflammatory etiologies. A diagnosis of VKH disease was established based on the clinical presentation, multimodal imaging findings, and revised diagnostic criteria. The patient was treated with high-dose intravenous methylprednisolone followed by a prolonged oral taper; azathioprine was initiated early as a steroid-sparing agent to prevent relapse.

CONCLUSIONS: This case underscores the importance of prompt ophthalmologic evaluation and multimodal imaging in the diagnosis of VKH disease. Early initiation of intensive immunosuppressive therapy may help limit inflammatory progression and reduce long-term complications.

Keywords: Autoimmune Diseases, Case Reports, Ophthalmology, Vision Disorders, Vogt-Koyanagi-Harada Disease