Vogt-Koyanagi-Harada Syndrome Masquerading as Isolated Headache Despite a Reassuring Workup: A Case Report

Vogt-Koyanagi-Harada (VKH) syndrome is an autoimmune disease that can present with non-specific prodromal symptoms such as headache, and when the diagnosis is delayed, it can progress to legal blindness.We present a case of a 48-year-old female with type 2 diabetes, hyperlipidemia, and class II obesity who presented with progressive frontal headache radiating to the malar region, followed by bilateral ocular pain, blurred vision, and photopsia.Examination and imaging demonstrated bilateral multifocal exudative retinal detachments, choroidal folds, and disc edema with angiographic findings of active choroidal inflammation; infectious and autoimmune mimickers were excluded, and she met diagnostic criteria for acute VKH.High-dose corticosteroids produced only transient improvement, with recurrence on taper.Adalimumab achieved marked improvement, but coverage was subsequently discontinued for nonmedical, insurance-related reasons, prompting transition to mycophenolate mofetil, which maintained clinical improvement through six months of follow-up.This case underscores that VKH, and systemic inflammatory disease more broadly, can hide behind isolated headache despite an entirely reassuring initial workup, and that a normal early evaluation should not close the diagnostic loop when visual symptoms are present.Secondarily, we describe an alternative regimen with second-line treatment with mycophenolate mofetil when biologic access is interrupted for non-medical reasons.