f i [,/
Case 9-4. Presumed Ocular Histoplasmosis Syndrome
A 54-year-old woman reported a three day history of a gray spot in her right central vision. Her visual acuity in this eye was 20/60. Slit-lamp examination (A) revealed mild peripapillary atrophy, punched out chorioretinal lesions in the mid-periphery, and a single atrophic lesion in the central macula consistent with a clinical diagnosis of presumed ocular histoplasmosis syndrome. There was no evidence of subretinal fluid or exudate. Fluorescein angiography (B) displayed a well circumscribed hyperfluo-rescent lesion in the central macula with a reticular pattern of mild surrounding hyperfluorescence*
A horizontal scan (C) directly through fixation showed loss of the normal contour of the fovea! pit and mild sub-foveal fluid accumulation- The subretinal fluid appeared mildly backscattering, in contrast to transparent serous fluid. An image (D) acquired through the central atrophic lesion displayed a well-defined region of decreased reflectivity from Hie retinal pigment epithelium (RPE), and an associated increase in backscattering from the choroid below, consistent with a chorioretinal lesion. The inner retinal layers appeared elevated and compressed above the lesion.
The patient started oral prednisone therapy and returned two months later with an improvement in visual acuity to 20/20, A repeat scan (E) through the fovea showed that the subretinal fluid had resolved. A significant improvement in the chorioretinal lesion was also noted on OCT (F), which demonstrated reduced disruption of the retinal layers and RPE in this area. Onlv a slight increase in the choroidal reflectivity remained.
Was this article helpful?