Importance of proper diagnosis for management: multifocal choroiditis mimicking ocular histoplasmosis syndrome

Abstract

Purpose: The study aims to evaluate a series of patients with initial diagnosis of ocular histoplasmosis syndrome (OHS) with progression and response to treatments consistent with multifocal choroiditis (MFC).

Methods: Retrospective review of nine patients referred for management of recurrent OHS lesions. Serology panel was conducted to rule out autoimmune and infectious causes.

Results: Clinical examination revealed multiple small, punched-out peripheral chorioretinal scars, and peripapillary atrophy. Histoplasma antigen/antibody was negative in all patients. Fluorescein angiography and optical coherence tomography confirmed active inflammation in five patients. Immunomodulatory therapy (IMT) was initiated to control active inflammation. While on IMT, visual acuity stabilized or improved in three patients with no recurrence of CNV or lesion activities over the follow-up period.

Conclusions: MFC may initially masquerade as OHS. Clinical characteristics of recurrent MFC and absence of histoplasma titer may lead to consideration of IMT and other proper treatments for MFC.

Fig. 1

The Optos™ P-200° digital fundus image of patient 6 illustrates chorioretinal lesions inferiorly in both eyes. Lesions in the left eye are more prominent than those in the right eye. There is a yellowish lesion just inferonasal to foveal center of the left eye

Fig. 2

a Fundus image of the right eye of patient 5 illustrates multiple chorioretinal lesions, which concentrates within the macula. There is a deep chorioretinal scar on the temporal aspect of foveal center with no subretinal fluid. b, c Fluorescein angiography of right eye demonstrates classical choroidal neovascularization (CNV) filling pattern with chorioretinal anastomosis in the center without prominent leakage in early b and mid c phases. d, e Optical Coherence Tomography of right eye shows hyperreflective substance within the retinal pigment epithelium (RPE)/choroid complex, with no intra-retinal edema