Neck stiffness and papilloedema due to Harada syndrome.

A 41-year old previously healthy woman presented with severe headache, vomiting, low grade fever, bilateral eye pain, photophobia and deteriorating vision over one week. Examination showed neck stiffness and bilateral papilloedema [Figures 1 and 2]. She had no evidence of autoimmune disorders. Contrast CT brain and routine investigations were normal. CSF showed pleocytosis with negative microbiological tests. Worsening visual acuity in the absence of meningitis or an intracranial space occupying lesion prompted an urgent ophthalmological assessment which showed bilateral disc oedema with multiple exudative detachments of the sensory retina with vitreal cells, suggestive of posterior uveitis. This led to the clinical diagnosis of an incomplete form of Harada syndrome, as she had no auditory or cutaneous signs [1]. She had an excellent response to intravenous methylprednisolone followed by oral steroids. Serial visual and fundoscopy assessments showed gradual improvement in visual acuity, disc oedema and retinal Neck stiffness and papilloedema due to Harada syndrome