Diagnostic and Management Challenges in Atypical Central Serous Chorioretinopathy Mimicking Vogt-Koyanagi-Harada Disease: A Case Report.

Central serous chorioretinopathy (CSCR) is characterized by serous detachment of the neurosensory retina and is considered part of the pachychoroid spectrum. Vogt-Koyanagi-Harada (VKH) disease, in contrast, is characterized by bilateral granulomatous panuveitis, exudative retinal detachments, and choroidal thickening. As both are primarily diseases of the choroid, the rare clinical overlap between atypical CSCR and VKH disease can complicate diagnosis. We report a case of atypical CSCR mimicking VKH disease, highlighting the diagnostic and treatment challenges. A 50-year-old woman presented with bilateral progressive reduction in vision over three months, accompanied by headaches and tinnitus. Ocular examination revealed bilateral exudative retinal detachment, and she was diagnosed with acute incomplete VKH disease. Despite systemic corticosteroid therapy, her condition worsened, leading to a revised diagnosis of VKH disease with steroid-induced CSCR. Systemic corticosteroids were tapered and discontinued due to CSCR development. Subsequent surgical interventions, including vitreous biopsy, vitrectomy, subretinal fluid drainage, and silicone oil tamponade, were carried out. One month postoperatively, recurrent exudative retinal detachment occurred. With a suspicion of masquerade syndrome, she underwent left eye removal of oil, retinal and choroidal tissue biopsy, subretinal fluid sampling and drainage, endolaser, and silicone oil tamponade. Histopathological examination and biopsies revealed no malignancy, infection, or inflammation. Postoperatively, visual improvement was limited due to chronic exudative retinal detachment. Ultimately, the diagnosis was revised to atypical CSCR based on clinical findings, disease progression, and multimodal imaging. Atypical bullous retinal detachment is a rare manifestation, emphasizing the need to consider this variant in cases of serous retinal detachment. Timely recognition is essential to guide appropriate treatment and minimize visual complications.