a 36-year - old woman was referred for blurred vision in both eyes that had lasted for three days . she had been diagnosed with graves ' disease one year previously and was treated with methimazole . however , she had discontinued the methimazole seven months prior , because she was diagnosed with methimazole - induced hypersensitivity following development of a skin rash . after discontinuing the methimazole , after symptoms developed , she was taken to the hospital for evaluation of systemic diseases in the allergy division of the department of internal medicine . she was referred to retinal clinic for ocular examination . on examination , her best - corrected visual acuities ( bcva ) were 20/100 in both eyes . a fundus examination showed disc edema accompanied by a serous retinal detachment in both eyes ( fig . 1 a and b ) . fluorescein angiography ( fag ) showed multiple leaks at the posterior pole ( fig . 1 c and d ) . we decided to observe the patient closely with predisolone tapering to 5 mg for 1 week . after seven days , the patient 's visual acuity did not change , but the subretinal fluid buildup and the retinal detachment worsened . the leakage pattern on fag changed ( fig . 2 a and b ) , and indocyanine green angiography revealed multiple hypofluorescent spots ( fig . 2 c and d ) . the patient was diagnosed with vkh disease and treatment with high dose steroid pulse therapy was recommended . although the internal medicine physicians were reluctant to use steroids due to the patient 's steroid - induced myopathy , intravenous administration of 500 mg of methylprednisolone for three days followed by 30 mg prednisolone with 75 mg of cyclosporine per day was provided . fundus examination showed attached retinas bilaterally , and fag revealed that the leaks had resolved in both eyes ( fig . since both vkh and graves ' disease are caused by t cell - mediated autoimmune dysfunction , they might share a common pathogenic process.3,4 moreover , in this case , altered immune regulation that may have resulted from drug - induced hypersensitivity may have contributed to the development of vkh . although our patient received 10 mg of prednisolone , this did not prevent the development of vkh . this case study illustrates the diagnostic and therapeutic challenges of vkh - associated autoimmune diseases .
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 .