Case of the Month I October 2020

Case of the Month
October 20, 2020

The Case

The patient was a 28-year-old woman referred for fundus changes in the left eye. She had no acute complaints. Her past medical history was unremarkable. The visual acuity without correction was 20/30 J1+ OD and 20/25 J1+ OS. Other than the fundus findings visible on the photos, the examination of each eye was unremarkable. What was the most likely diagnosis, and was any treatment needed?

There are punched-out chorioretinal scars in the left eye aligned in a curvilinear distribution in the temporal mid-periphery and a single punched-out lesion in the inferior periphery of the right eye. This finding points to either ocular histoplasmosis syndrome or multifocal choroiditis (MFC). This patient had never been to an area where histoplasmosis is endemic, making the latter diagnosis unlikely. She had about 4 diopters of myopia, and MFC patients typically are moderate myopes. MFC is usually but not always bilateral. Many patients have peripapillary atrophy. There are often vitreous cells, but if the condition has been quiescent for an extended period of time the vitreous can be quiet. MFC can cause a choroidal neovascular membrane to develop, particularly if there is a punched-out lesion in the macula. This patient appeared to be at low risk, and observation was warranted.

Case Photos

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There are punched-out chorioretinal scars in the left eye aligned in a curvilinear distribution in the temporal mid-periphery and a single punched-out lesion in the inferior periphery of the right eye. This finding points to either ocular histoplasmosis syndrome or multifocal choroiditis (MFC). This patient had never been to an area where histoplasmosis is endemic, making the latter diagnosis unlikely. She had about 4 diopters of myopia, and MFC patients typically are moderate myopes. MFC is usually but not always bilateral. Many patients have peripapillary atrophy. There are often vitreous cells, but if the condition has been quiescent for an extended period of time the vitreous can be quiet. MFC can cause a choroidal neovascular membrane to develop, particularly if there is a punched-out lesion in the macula. This patient appeared to be at low risk, and observation was warranted.

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