{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T11:14:00Z","timestamp":1788779640376,"version":"build-2803163510"},"reference-count":13,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":76,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Ophthal Inflamm Infect"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To describe an atypical late-onset presentation of Vogt\u2013Koyanagi\u2013Harada (VKH) disease initially interpreted as autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A) in association with an ovarian teratoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A 59-year-old woman presented with bilateral optic disc edema, visual field defects, and headache following a flu-like illness. Comprehensive ophthalmologic, neurologic, and systemic evaluation was performed, including multimodal ocular imaging, cerebrospinal fluid (CSF) analysis with antibody testing, and neuroimaging. Clinical course and response to corticosteroid therapy were assessed longitudinally.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Initial findings, including CSF anti-GFAP positivity, lymphocytic pleocytosis, white matter lesions, and an ovarian teratoma, supported a diagnosis of GFAP-A. However, sequential multimodal imaging revealed diffuse, steroid-responsive choroidal inflammation with choroidal thickening, folds, mild subretinal fluid, hypocyanescent dark dots on indocyanine green angiography, fluorescein angiography pinpoints, and bilateral hot discs. Granulomatous anterior uveitis and subsequent choroidal depigmentation further supported VKH. Bilateral sensorineural hearing loss was also consistent with this diagnosis. The longitudinal ocular phenotype proved more consistent with VKH than with primary astrocytopathy-related optic neuropathy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Late-onset VKH may present predominantly with optic disc edema and central nervous system involvement, closely mimicking inflammatory neurologic disease. Recognition of subtle choroidal inflammation and integration of longitudinal multimodal imaging are essential to avoid misdiagnosis and guide appropriate immunosuppressive management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12348-026-00616-8","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T11:25:10Z","timestamp":1782213910000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Late-onset optic disc swelling-type Vogt\u2013Koyanagi\u2013Harada disease: diagnostic value of longitudinal multimodal imaging"],"prefix":"10.1186","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2060-5870","authenticated-orcid":false,"given":"Tetiana","family":"Goncharova","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Garcia-Hidalgo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar Balaguer","family":"Sole","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armand","family":"Pair\u00f3-Salvador","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yann","family":"Bertolani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Kirkegaard-Biosca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Distefano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"key":"616_CR1","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1007\/s10384-014-0367-8","volume":"59","author":"Y Okunuki","year":"2015","unstructured":"Okunuki Y, Tsubota K, Kezuka T, Goto H (2015) Differences in the clinical features of two types of Vogt-Koyanagi-Harada disease: serous retinal detachment and optic disc swelling. Jpn J Ophthalmol 59:103\u2013108","journal-title":"Jpn J Ophthalmol"},{"key":"616_CR2","doi-asserted-by":"publisher","first-page":"1917","DOI":"10.1167\/iovs.11-8984","volume":"53","author":"K Nakao","year":"2012","unstructured":"Nakao K, Abematsu N, Mizushima Y, Sakamoto T (2012) Optic disc swelling in Vogt-Koyanagi-Harada disease. Invest Ophthalmol Vis Sci 53:1917\u20131922","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"616_CR3","doi-asserted-by":"publisher","first-page":"1297","DOI":"10.1001\/jamaneurol.2016.2549","volume":"73","author":"B Fang","year":"2016","unstructured":"Fang B, McKeon A, Hinson SR et al (2016) Autoimmune glial fibrillary acidic protein astrocytopathy. JAMA Neurol 73:1297\u20131307","journal-title":"JAMA Neurol"},{"key":"616_CR4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00401-023-02678-7","volume":"147","author":"Y Guo","year":"2024","unstructured":"Guo Y, Endmayr V, Zekeridou A et al (2024) New insights into neuropathology and pathogenesis of autoimmune glial fibrillary acidic protein meningoencephalomyelitis. Acta Neuropathol 147:1\u201312","journal-title":"Acta Neuropathol"},{"key":"616_CR5","first-page":"1","volume":"31","author":"KM McKay","year":"2023","unstructured":"McKay KM, Nishath T, Grieco VS, Stacey AW (2023) Diagnostic confirmation of choroidal lymphoma by anterior chamber paracentesis and aqueous fluid flow cytometry. Ocul Immunol Inflamm 31:1\u20136","journal-title":"Ocul Immunol Inflamm"},{"key":"616_CR6","doi-asserted-by":"publisher","first-page":"899","DOI":"10.1159\/000520036","volume":"12","author":"Y Yamashita","year":"2021","unstructured":"Yamashita Y, Hashimoto Y, Namba K, Mizuuchi K, Ishida S (2021) Optic nerve head microcirculation in eyes with Vogt-Koyanagi-Harada disease accompanied by anterior ischemic optic neuropathy. Case Rep Ophthalmol 12:899\u2013908","journal-title":"Case Rep Ophthalmol"},{"key":"616_CR7","doi-asserted-by":"publisher","first-page":"1417","DOI":"10.1007\/s00417-009-1125-3","volume":"247","author":"K Nakao","year":"2009","unstructured":"Nakao K, Mizushima Y, Abematsu N, Goh N, Sakamoto T (2009) Anterior ischemic optic neuropathy associated with Vogt-Koyanagi-Harada disease. Graefes Arch Clin Exp Ophthalmol 247:1417\u20131425","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"616_CR8","doi-asserted-by":"publisher","first-page":"1339609","DOI":"10.3389\/fmed.2024.1339609","volume":"11","author":"X Liu","year":"2024","unstructured":"Liu X, Wang S, An Y, Zhang H (2024) Enhanced depth imaging optical coherence tomography features of two types of Vogt-Koyanagi-Harada disease: fuzzy or lost pattern of the choroidal vasculature is of diagnostic value. Front Med 11:1339609","journal-title":"Front Med"},{"key":"616_CR9","doi-asserted-by":"publisher","first-page":"101445","DOI":"10.1016\/j.preteyeres.2026.101445","volume":"111","author":"L Xia","year":"2026","unstructured":"Xia L, Chen L, Dai L et al (2026) Vogt-Koyanagi-Harada disease under the lens: Insights from multimodal ocular imaging. Prog Retin Eye Res 111:101445","journal-title":"Prog Retin Eye Res"},{"issue":"4","key":"616_CR10","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1002\/ana.26195","volume":"90","author":"G Tewkesbury","year":"2021","unstructured":"Tewkesbury G, Song JW, Perrone CM (2021) Magnetic Resonance Imaging of Autoimmune GFAP Astrocytopathy. Ann Neurol 90(4):691\u2013692","journal-title":"Ann Neurol"},{"key":"616_CR11","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1016\/j.msard.2017.01.003","volume":"12","author":"H Algahtani","year":"2017","unstructured":"Algahtani H, Shirah B, Algahtani R, Alkahtani A, Alwadie S (2017) Vogt-Koyanagi-Harada syndrome mimicking multiple sclerosis: a case report and review of the literature. Mult Scler Relat Disord 12:44\u201348","journal-title":"Mult Scler Relat Disord"},{"issue":"3","key":"616_CR12","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1001\/jamaneurol.2024.4749","volume":"82","author":"SJ Pleasure","year":"2025","unstructured":"Pleasure SJ, Green AJ (2025) Autoimmune Inflammatory Astrocytopathies-Is the Spectrum Expanding? JAMA Neurol 82(3):218\u2013219","journal-title":"JAMA Neurol"},{"key":"616_CR13","doi-asserted-by":"publisher","first-page":"892539","DOI":"10.3389\/fonc.2022.892539","volume":"12","author":"J Lin","year":"2022","unstructured":"Lin J, Wang M, Wang J, Li J (2022) Ovarian Teratoma-Related Paraneoplastic Neurological Syndromes. Front Oncol 12:892539 Published 2022 May 16. https:\/\/doi.org\/10.3389\/fonc.2022.892539","journal-title":"Front Oncol"}],"container-title":["Journal of Ophthalmic Inflammation and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12348-026-00616-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12348-026-00616-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12348-026-00616-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T11:05:15Z","timestamp":1788779115000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12348-026-00616-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,23]]},"references-count":13,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["616"],"URL":"https:\/\/doi.org\/10.1186\/s12348-026-00616-8","relation":{},"ISSN":["1869-5760"],"issn-type":[{"value":"1869-5760","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,23]]},"assertion":[{"value":"26 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Not applicable.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The written informed consent for the publication of this article was obtained from the participant.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"53"}}