A COVID-19 perspective of Vogt–Koyanagi–Harada disease

Vogt–Koyanagi–Harada (VKH) disease, a bilateral granulomatous panuveitis associated with multisystem involvement, is a T-cell-mediated autoimmune disorder in which cytotoxic T-cell target melanocytes in genetically susceptible individuals. Recently, there has been an increase in literature on the new onset of uveitis and reactivation of previously diagnosed cases of uveitis following Covid-19 vaccinations. It has been postulated that Covid-19 vaccines can lead to an immunomodulatory change resulting in an autoimmune phenomenon in the recipients. VKH following COVID-19 infection was reported in four patients and a total of 46 patients developing VKH or VKH-like disease following COVID-19 vaccinations. There are reports of four patients who had been recovering or recovered from VKH after receiving the first dosage of the vaccine and developed worsening of ocular inflammation after receiving the second dose of the vaccine.

Autofluorescence combined with spectral domain optical coherence tomography for diagnosis and follow-up of acute Vogt-Koyanagi-Harada disease / 南方医科大学学报

OBJECTIVE@#To evaluate the value of fundus autofluorescence (FAF) imaging combined with spectral domain optical coherence tomography (SD-OCT) in diagnosis, prognostic assessment and follow-up observation of acute Vogt-KoyanagiHarada (VKH) disease.@*METHODS@#Clinical data were collected from 12 patients (23 eyes) with acute VKH disease treated in our hospital from May, 2018 to November, 2019, including detailed medical history, best corrected visual acuity (BCVA), and results of slit lamp biomicroscopy, fundus photography, SD-OCT, fundus fluorescein angiography (FFA) and FAF imaging.SDOCT and FAF imaging were repeated after a course of treatment and in follow-up examination, and the results were compared with those at the time of admission.@*RESULTS@#VKH disease involved both eyes in 11 patients (91.7%).Fundus photography showed optic disc edema in 16 eyes (69.6%), and multiple retinal neuroepithelial detachment was detected by SD-OCT in all the involved eyes (100%).IN all the eyes, FFA revealed small and dense fluorescein leakage in the early stage and fluorescein accumulation in advanced stages of VHK disease to form multiple dye pooling in the areas of serous detachment.Hyperauto fluorescence was a common finding in FAF imaging (100%), and the area involved was consistent with that of fluorescein accumulation shown by FAF imaging.Ten eyes (43.5%) showed patches of relative hypoautofluorescence in the hyperauto fl uorescence areas, and granular hyperauto fl uorescence was found in the lesions in 4 eyes (17.4%).During the remission period of VKH disease, FAF imaging showed normal finding in 8 eyes (34.8%) and reduced areas (by 55.2%) and intensity (by 46.5%) of hyperautofluorescence in 9 eyes (39.1%).In 6 eyes (26.1%), only a few hyperautofluorescent spots scattered in the macula were observed.SD-OCT demonstrated significantly reduced (by 69.5% on average) or even disappearance of subretinal fluid in the eyes.The fluorescence intensity in FAF imaging showed a significant positive correlation with the volume of subretinal fluid detected by SD-OCT (@*CONCLUSIONS@#The combination of fluorescein angiography, FAF imaging and SD-OCT can significantly improve the diagnostic accuracy of VKH disease.FAF imaging combined with SD-OCT provides an effective and noninvasive modality for evaluation of remission and monitoring the changes in VKH disease.

Clinicopathological and immunohistochemistry correlation in a case of Vogt-Koyanagi-Harada disease

Vogt-Koyanagi-Harada (VKH) disease is a systemic disorder causing bilateral panuveitis. Histopathological documentation along with molecular diagnostic evidence in VKH eye is a rarity. We present a 46-year-old woman with VKH with several ocular complications and subsequently enucleation of the right eye was done because of painful blind eye. Patient had clinical complications of VKH and some of the complications were observed in histopathology. Pathology of the case showed nongranulomatous uveitis, indicating the disease in chronic recurrent stage. Immunohistochemistry showed predominant T-cell involvement in this case. The case showed clinicopathological and immunohistochemistry correlation in a case of VKH disease.

Hipoacusia en enfermedad de Vogt-Koyanagi-Harada: caso clínico y revisión de literatura / Hearing loss in Vogt-Koyanagi-Harada Disease: case report and literature review

RESUMEN La patología autoinmune de oído interno se caracteriza por presentar hipoacusia sensorioneural bilateral, asimétrica y progresiva, que responde a terapia médica, presentándose aislada o como parte de una enfermedad sistémica como la enfermedad de Vogt-Koyanagi-Harada. Se presenta el caso de una paciente que consulta por cefalea, visión borrosa y sintomatología audiológica, con diagnóstico de enfermedad de Vogt-Koyanagi-Harada. Revisamos la literatura disponible respecto a la enfermedad y sus manifestaciones otológicas.

ABSTRACT Autoimmune inner ear disease presents a bilateral, asymmetric and progressive sensorineural hearing loss, that responds to medical therapy, presenting alone or associated to a systemic disease such as Vogt-Koyanagi-Harada disease. We present the case of a patient with headache, blur vision and audiologic symptoms, diagnosed with Vogt-Koyanagi-Harada disease. We review the literature about the disease and its otologic manifestations.

A Case of Intravitreal Dexamethasone Implantation in a Patient with Vogt-Koyanagi-Harada Disease

PURPOSE: To report a case of Vogt-Koyanagi-Harada (VKH) disease with chronic recurrence, which was treated with intravitreal dexamethasone implantation. CASE SUMMARY: A 39-year-old female presented with decreased visual acuities in both eyes accompanied by headaches and tinnitus the previous week. On fundus examination and optical coherence tomography, multiple serous retinal detachments with subretinal septa were observed in both eyes, and she was diagnosed with VKH disease. After undergoing high dose intravenous steroid therapy at another hospital, she was treated with oral prednisolone and immunosuppressant drugs. However, she showed frequent recurrences, and also complained of side effects from prolonged systemic steroids. We then performed intravitreal injections of dexamethasone implants in both eyes at 3-week intervals. One month following the injections, the inflammations in the anterior chamber and vitreous opacities were improved. Until the last visit at 6 months after the injection, there was no significant recurrence of inflammation, although oral prednisolone had been tapered. CONCLUSIONS: In VKH disease, intravitreal dexamethasone implantation may be an effective treatment option if chronic recurrence occurs, despite systemic steroid and immunosuppressant therapy or sustained treatment being difficult to maintain because of side effects.

A Case of Atypical Vogt-Koyanagi-Harada Disease Preceded by Acute Angle Closure Glaucoma

PURPOSE: To report a case of atypical Vogt–Koyanagi–Harada disease that occurred after an acute angle closure glaucoma attack. CASE SUMMARY: A 48-year-old female presented with bilateral visual disturbance accompanied by headache and ocular pain. The patient had no specific past medical or family history except taking oral contraceptives for 10 years. Despite the normalization of intraocular pressure in a local clinic, a shallow-depth anterior chamber and forward displacement of the iris–lens diaphragm remained unresolved. The depth of the anterior chamber had increased in both eyes after laser therapy but without recovery of her visual acuity. B-scans showed ciliochoroidal effusion. Anterior chamber inflammation was observed in both eyes. Optical coherence tomography showed lobulated and serous retinal detachment involving the macula of both eyes. However, fluorescence angiography findings showed no multiple hyperfluorescence, which is unusual for typical cases of Vogt–Koyanagi–Harada disease. The patient was diagnosed with atypical Vogt–Koyanagi–Harada disease and was treated with eyedrops and intravenous steroid pulse therapy, after which she was converted to oral medications with immunosuppressants. After 1 month, no serous retinal detachment was detected. After 3 months, best corrected visual acuity (logMAR) was 0.0 in both eyes, and there has been no recurrence on follow-up. CONCLUSIONS: Atypical Vogt–Koyanagi–Harada disease at presentation can mimic acute attacks of angle closure glaucoma. Therefore, if there is no improvement after treatment for angle closure glaucoma including laser iridotomy, other diseases including Vogt–Koyanagi–Harada disease must be considered and the patient should be closely monitored.

F-18 FDG PET Findings for Vogt-Koyanagi-Harada Disease / 대한핵의학회잡지

Vogt-Koyanagi-Harada disease is a rare multisystemic granulomatous autoimmune disorder affecting pigmented tissues such as the choroid, meninges, inner ear, and the skin. Neurologic symptoms are usually mild. Clinical manifestations include generalized muscle weakness, headache, meningismus, vertigo, decreased visual acuity, hearing loss and mental changes ranging from mild confusion to psychosis, hemiparesis, dysarthria, and aphasia. Seizures are very rare. We describe a case of ¹⁸F-fluorodeoxyglucose (F-18 FDG) positron emission tomography (PET) and software-fused PET-magnetic resonance imaging (MRI) in Vogt-Koyanagi-Harada disease with seizure.

Distinguishing Vogt-Koyanagi-Harada disease from multiple central serous chorioretinopathy with OCT and FFA / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To observe the image features of Vogt-Koyanagi-Harada disease (VKH) and multiple central serous chorioretinopathy (CSC) by fundus fluorescein angiography (FFA) and optical coherence tomography (OCT).METHODS:Thirty-two eyes of 17 patients with VKH and thirty-five eyes of 30 patients with multiple CSC were collected from 2009 to 2016 in my hospital.RESULTS:All the eyes with VKH were found small and dense fluorescein leakage in the early stage.The 17 eyes (53%) with VKH were found fluorescein accumulation in the final stage;24 eyes (75%) with VKH were found high fluorescence of optic disc.All of eyes with multiple CSC were found multifocal leakage in the early stage.And 2 eyes (6%) with multiple CSC were found high fluorescence of optic disc.There were 28 eyes (14 patients) with VKH and 25 eyes (22 patients) with multiple CSC had been done OCT in my hospital.Retinal pigment epithelial fold was only found in VKH.Fluctuation of internal limiting membrane (ILM) and membrane structure had higher sensitivity to diagnostic VKH from to multiple CSC, with sensitivity of 54% and 68% respectively.CONCLUSION:There are some similarities as well as differences between FFA and OCT in diagnosis of VKH and multiple CSC.A combination usage of FFA and OCT can be more effective in distinguishing VKH from multiple CSC.

The Hidden Salmon Patch: Ocular Lymphoma Mistaken as Vogt Koyanagi Disease

Ocular inflammation from various causes may have similar clinical presentation thus careful clinical evaluations are mandatory particularly when the disease appear to be resistant to treatment. This paper reports a case of ocular lymphoma which was initially treated as Vogt Koyanagi Harada disease at a different centre. A 65-year-old Sudanese man complained of gradual worsening left eye vision. Careful ocular and slit lamp examination revealed a conjunctival lesion with choroidal infiltration as well as exudative retinal detachment. Computed tomography scan (CT scan) showed left eye axial proptosis, and a homogenous enhancing mass at the posterior coat of the globe. Tissue biopsy of the conjunctival lesion revealed marginal Zone B cell (MALT type), low grade, non-Hodgkin’s lymphoma. AS the ocular signs and symptoms progressed, chemotherapy was initiated. The proptosis, exudative retinal detachment, disc hyperemia and swelling improved after chemotherapy. The post treatment CT scan showed reduction of the posterior ocular coat mass. The possibility of malignant lymphoma should be considered in patients with resistant uveitis despite administration of corticosteroid. Ocular lymphoma is an indolent tumour with good prognosis. Careful ocular examination, adequate imaging studies followed by early surgical biopsy will contribute to early diagnosis.

Enfermedad de Vogt-Koyanagi-Harada y rehabilitación visual / Vogt-Koyanagi-Harada disease and visual rehabilitation

La enfermedad de Vogt-Koyanagi-Harada es una entidad infrecuente, multisistémica, de etiología desconocida, presuntamente autoinmune, caracterizada por panuveítis granulomatosa crónica bilateral y difusa, acompañada de participación tegumentaria, neurológica y auditiva, que afecta con mayor frecuencia la raza no caucasiana y, por lo general, a mujeres. Se presenta generalmente entre los 20-50 años de edad. Su incidencia varía geográficamente. Se estima que el 25 por ciento de los pacientes con esta enfermedad son ciegos legales; que el 25 por ciento puede presentar baja visión y el 50 por ciento agudeza visual mayor de 20/50. Se presenta una paciente de 50 años de edad con antecedentes de enfermedad de Vogt-Koyanagi-Harada, de 8 años de evolución, quien ha llevado tratamiento con antinflamatorios esteroideos sistémicos e inmunosupresores, así como terapia de apoyo con antinflamatorios esteroideos tópicos y ciclopléjicos. Acudió a la consulta de baja visión y se le realizó examen oftalmológico completo, estudios complementarios y se rehabilitó mediante el uso de ayudas ópticas y no ópticas para lograr el mayor aprovechamiento de su resto visual(AU)

Vogt-Koyanagi-Harada (VKH) is a rare, multisystemic, allegedly autoimmune disease of unknown etiology. It is characterized by chronic bilateral granulomatous and diffuse panuveitis, accompanied by tegumentary, neurological and hearing impairments that often affect the non-Caucasians and usually women. It usually occurs in the 20-25 years age group and its incidence varies with the geographic location. It is estimated that 25 percent of the patients with this disease are legally blind, the other 25 percent may have low vision and 50% present with visual acuity over 20/50. There is a 50 years-old patient with a history of Vogt - Koyanagi - Harada disease for 8 years. He had been treated with systemic steroid anti-inflammatory drugs and immunosuppressive therapy as well as supporting therapy with topical and cycloplegic steroid anti-inflammatories. The patient had gone to the low vision service looking for rehabilitation. He was performed a complete eye examination, supplementary studies and he was finally rehabilitated through the use of optical and non-optical aids in order to maximize his remaining vision(AU)

Spectral-Domain Optical Coherence Tomography Findings of Vogt-Koyanagi-Harada Disease

PURPOSE: To report characteristics of Vogt-Koyanagi-Harada (VKH) disease as observed on spectral-domain optical coherence tomography (SD-OCT) images. CASE SUMMARY: (Case 1) A 38-year-old female presented with visual impairment in both eyes. On fundus examination, multifocal serous retinal detachment in the posterior pole was observed in both eyes. On enhanced SD-OCT, serous retinal detachment and cystoid macular edema in the outer retina were observed and the intraretinal fluid space was divided by a membranous structure forming an intraretinal compartmentalized cystic space. Under the diagnosis of VKH disease, the patient was treated with intravenous administration of methylprednisolone. After treatment, enhanced SD-OCT images showed decreased serous retinal detachment. (Case 2) A 58-year-old male presented with visual impairment in both eyes. On fundus examination, multifocal serous retinal detachment in the posterior pole was observed in both eyes. On enhanced SD-OCT, choroidal folds were observed and the membranous structure showed continuity with ellipsoid zone, suggesting the membranous structure was part of the outer photoreceptor layer of the adjacent attached retina. The patient was treated with intravenous administration of methylprednisolone. After treatment, enhanced SD-OCT images showed cystic space was decreased. CONCLUSIONS: SD-OCT images of VKH disease demonstrated multiple serous retinal detachments and intraretinal compartmentalized cystic space divided by a membranous structure. The membranous structure may be considered a part of the outer photoreceptor layer of the attached retina.

Comparison of the Clinical Manifestations between Acute Vogt-Koyanagi-Harada Disease and Acute Bilateral Central Serous Chorioretinopathy

PURPOSE: To compare clinical, angiographic, and optical coherence tomographic characteristics between eyes with acute Vogt-Koyanagi-Harada (VKH) disease and eyes with acute bilateral central serous chorioretinopathy (CSC), and to demonstrate distinguishing features between the two diseases in confusing cases. METHODS: The medical records of 35 patients with VKH disease and 25 patients with bilateral CSC were retrospectively reviewed. Characteristics according to slit-lamp biomicroscopy, ophthalmoscopy, fundus photography, fluorescein angiography, indocyanine green angiography, and spectral-domain optical coherence tomography were compared between the two diseases. RESULTS: Five of 35 patients (10 of 70 eyes, 14.3%) with VKH disease were initially misdiagnosed as CSC patients, and six of 25 patients (12 of 50 eyes, 24%) with bilateral CSC were initially misdiagnosed as patients with VKH disease. Pigment epithelial detachment in CSC and optic disc hyperemia in VKH disease show the highest positive predictive values of 100% for each disease. CONCLUSIONS: Optic disc hyperemia in VKH disease and pigment epithelial detachment in bilateral CSC are the most specific clinical manifestations of each disease at initial patient presentation.

<b>A Case of New-Onset Vogt-Koyanagi-Harada Disease Successfully Treated with the Ryutanshakanto Prepared </b><b>at Ikkando and Goreisan and no Corticosteroids </b> / 日本東洋医学雑誌

Vogt-Koyanagi-Harada (VKH) disease is the second most common uveitis in Japan. This is considered an autoimmune disease as the immune system attacks self-melanocytes, and it is characterized by neurological, auditory, and dermatological symptoms in addition to panuveitis. Standard treatment is systemic steroid mass therapy. Also, an inadequate amount of corticosteroid can cause the disease recur or become protracted.<br>Here, we report a case of new-onset VKH disease successfully treated with a combination of ryutanshakanto prepared at Ikkando and goreisan, without any corticosteroids, in a hepatitis B virus carrier.<br>The patient was a 40-year-old male. He visited an eye clinic with bilateral blurred vision, and was diagnosed with bilateral maculopathy at this clinic. He was then referred to our hospital. We diagnosed him with VKH disease and, in accordance with (traditional Japanese) Kampo medicine, also with dampness-heat (shitsunetsu) of the foot's liver meridian with reverting yin (<i>ashi-ketchin-kankei</i>), mild water retention (<i>suitai</i>) and blood stasis (<i>oketsu</i>). We then administered the ryutanshakanto prepared at Ikkando, plus goreisan. His visual acuity consequentially began to improve gradually from the next day, and the disease was finally cured without the administration of any corticosteroid. Thus we believe this suggests that Kampo therapy for VKH disease can be a viable alternative.

Vogt-Koyanagi-Harada Disease in a Pregnant Patient Successfully Treated with Intravitreal Triamcinolone Injection

PURPOSE: To report a case of Vogt-Koyanagi-Harada (VKH) disease in a pregnant patient treated with intravitreal triamcinolone injection. CASE SUMMARY: A 21-year-old female in the 19th week of gestation presented with bilateral blurring of vision associated with mild headache and tinnitus. Her initial best corrected visual acuity was 0.15 in the right eye and 0.3 in the left eye. Multiple serous retinal detachment and anterior chamber inflammation were observed, and VKH disease was diagnosed. Because of her pregnancy, the patient did not want high-dose systemic prednisolone therapy which may cause an abortion or low birth weight infant when used in a pregnant patient. Therefore, an intravitreal triamcinolone (4 mg/0.1 ml) injection was given in the right eye and topical steroid eye drops were used in the left eye. After 1 day, serous retinal detachment was significantly decreased and anterior chamber inflammation disappeared in the right eye. After 1 week, no serous retinal detachment was observed. In the left eye, serous retinal detachment was decreased after using steroid eye drops. After 10 days, serous retinal detachment disappeared but anterior chamber inflammation was still observed. After 1 month, best corrected visual acuity was 1.0 in both eyes and serous retinal detachment had not recurred. On follow-up, VKH disease had not recurred and a healthy normal weight infant was delivered. CONCLUSIONS: Intravitreal triamcinolone injection is an effective and safe treatment for VKH disease in pregnant women.

Acute Myelitis in a Patient with Vogt-Koyanagi-Harada Disease: Case Report and Review of the Literature

BACKGROUND: Vogt-Koyanagi-Harada (VKH) disease is characterized by bilateral granulomatous uveitis with neurologic, auditory, and dermatologic manifestations. However, acute myelitis complicating VKH disease has rarely been reported. CASE REPORT: A 50-year-old Chinese Han woman presented with difficulty walking, numbness on the left side of the body, and difficulty with urination. The patient was diagnosed with incomplete VKH disease and received corticosteroid treatment prior to the neurological presentation. Acute myelitis was diagnosed based on both clinical and spinal-cord MRI findings. CONCLUSIONS: Clinicians should consider acute myelitis as a rare possible neurological manifestation in VKH disease patients, and early systemic administration of corticosteroids will suppress the acute inflammatory process and prevent recurrences. This report raises the possibility that VKH disease and acute myelitis share common pathogenic pathways.

Vogt-Koyanagi-Harada disease occurring during pegylated interferon-alpha2b and ribavirin combination therapy for chronic hepatitis C / 대한간학회지

Vogt-Koyanagi-Harada (VKH) disease is a multisystem syndrome characterized by ocular (uveitis and retinal detachment), neurological (headache, tinnitus, and meningitis), and integumentary (vitiligo, alopecia, and poliosis) involvement. Although the pathogenesis of VKH disease is not well understood, an autoimmune T-cell response to a melanocyte-associated antigen is considered to be a cause of VKH disease. The complex immunological response to interferon and ribavirin may induce or exacerbate the autoimmune condition; however, VKH disease is a very rare complication associated with interferon therapy in chronic hepatitis C. We report a case of VKH disease occurring during pegylated interferon-alpha2b and ribavirin combination therapy for chronic hepatitis C.

Surgical Management of Atypical Vogt-Koyanagi-Harada Disease

PURPOSE: To report a case of surgical treatment of bilateral bullous exudative retinal detachment associated with Vogt-Koyanagi-Harada disease. CASE SUMMARY: A 64-year-old woman presented with decreased visual acuity, headache, and hearing loss for 2 months. Visual acuity was hand motion in the right eye and light perception in the left eye. Intraocular pressure was 16 mmHg in the right eye and 24 mmHg in the left eye. Slit lamp examimation disclosed corneal edema, conjunctival ciliary injection with chemosis, rubeosis iridis, and posterior synechia in both eyes. Fundus examination demonstrated bilateral bullous exudative retinal detachment. Lumbar puncture revealed pleocytosis and auditory function test showed neurosensory hearing loss. She was diagnosed as having bilateral bullous exudative retinal detachment associated Vogt-Koyanagi-Harada disease. On hospital day 3, intravitreal triamcinolone injection with external subretinal fluid drainage was performed in the right eye and on hospital day 6, intravitreal triamcinolone injection with external subretinal fluid drainage was performed in the left eye. Two months later, best corrected visual acuity was 0.2 in the right eye and 0.04 in the left eye. CONCLUSIONS: Intravitreal trimacinolone acetonide injection with external subretinal fluid drainage is one of the good treatment for bullous exudative retinal detachment associated with Vogt-Koyanagi-Harada disease.

Edema of the Photoreceptor Layer in Vogt-Koyanagi-Harada Disease Observed Using High-Resolution Optical Coherence Tomography

PURPOSE: To evaluate the characteristics of fluid accumulation in the uveitic stage of Vogt-Koyanagi-Harada (VKH) disease using high resolution optical coherence tomography (OCT3). METHODS: Twenty-eight eyes in 14 patients with VKH disease were reviewed retrospectively. These 28 eyes were divided into 19 eyes with intraretinal fluid (C group) and 9 eyes without intraretinal fluid (N group). Changes in visual acuity and fluid accumulation observed using OCT were compared between the two groups. RESULTS: Visual acuity at the time of presentation was significantly worse in the C group than in the N group (p=0.005). The photoreceptor layer appeared to be double-layered due to a cystoid space in the C group. Layered structures and strands found in the cystoid space. Expanding sponge-form edema led to the development of a cystoid space in the photoreceptor layer. Intraretinal fluid resolved earlier than subretinal fluid. There were no observed differences in visual acuity between the two groups after four days of treatment. CONCLUSIONS: Accumulation of intraretinal fluid was related to poor initial visual acuity, but not to final visual acuity. High resolution OCT findings indicate that edema of the photoreceptor layer participates in the development of a cystoid space.

A Case of Vogt-Koyanagi-Harada Disease in a Patient With Graves Disease

A case of Vogt-Koyanagi-Harada disease (VKH) that developed in a 36-year-old woman with Graves' disease was described. The patient was treated with Lugol's solution and presented with bilateral serous retinal detachment. She had also suffered from methimazole-induced hypersensitivity and steroid-induced myopathy. Fluorescein angiography showed multiple leakage points and a lumbar puncture revealed pleocytosis, which was compatible with VKH. High dose steroid pulse therapy was successful. Altered immune regulation associated with drug-induced hypersensitivity may contribute to the development of VKH in patients with Graves' disease.

Acute Lymphoblastic Leukemia Manifesting as Acute Vogt-Koyanagi-Harada Disease

We describe a case of bilateral exudative retinal detachment associated with prodromal symptoms simulating the presentation of acute Vogt-Koyanagi-Harada disease that was eventually diagnosed as acute lymphoblastic leukemia. A 42-year-old man presented with sudden visual loss in both eyes for two weeks. He complained of intermittent headache, neck stiffness and tinnitus for a month. His best-corrected visual acuities were 20/200 in both eyes. Fluorescein angiography, optical coherence topography and indocyanine green angiography featured bilateral serous retinal detachments. A clinical diagnosis of incomplete type Vogt-Koyanagi-Harada disease was considered. However, complete blood cell count showed a marked increase in the number of white blood cells and bone marrow examination revealed precursor B cell lymphoblastic leukemia. The patient started on induction chemotherapy. A week later, his best-corrected visual acuities were 20/25 and the serous retinal detachments were nearly absorbed in both eyes. Bilateral exudative retinal detachment associated with neurologic and auditory abnormalities may be a presenting sign of acute lymphoblastic leukemia. Clinicians should be aware of the possibility of leukemia in such patients.