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Open Access Highly Accessed Brief report

A diagnostic dilemma: infectious versus noninfectious multifocal choroiditis with panuveitis

Sharel Ongchin, C Dirk Keene, Russell Van Gelder and Gurunadh Atma Vemulakonda*

  • * Corresponding author: Gurunadh Atma Vemulakonda gatmav@uw.edu

Author Affiliations

University of Washington Eye Institute, 325 9th Ave, Box 359608, Seattle, WA, 98104, USA

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Journal of Ophthalmic Inflammation and Infection 2013, 3:26  doi:10.1186/1869-5760-3-26

Published: 28 January 2013

Abstract

Background

The objective of this study was to report a diagnostic dilemma in a patient with multifocal choroiditis. This is a case report study.

Findings

A 68-year-old female presented with new onset of floaters in both eyes and diagnosed with bilateral panuveitis. Her visual acuity was 20/200 in both eyes. Slit-lamp examination showed 1+ anterior chamber cells in both eyes. Ophthalmoscopic examination of both eyes showed vitreous cells, optic disc edema, small amounts of subretinal hemorrhage, and punctate choroidal lesions throughout the fundus. Laboratory work-up revealed a positive QuantiFERON-TB Gold result, and the patient was started on antituberculosis medications. However, given the patient’s intolerance to antituberculosis medications and progressive worsening of vision, she underwent a chorioretinal biopsy to assist with determining a definitive diagnosis. Biopsy results showed noncaseating granulomas and were negative for an infectious etiology. The patient was diagnosed with ocular sarcoidosis and started on immunomodulatory therapy for sarcoid-related multifocal choroiditis.

Conclusions

Multifocal chorioretinal lesions of unknown etiology can present as a diagnostic and therapeutic dilemma. Laboratory work-up is useful in determining an etiology; however, more invasive procedures, such as chorioretinal biopsy, may be necessary to guide treatment.

Keywords:
Multifocal choroiditis; Sarcoidosis; Mycobacterium tuberculosis; Granulomatous inflammation