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Early Progressive Circumpapillary Lesion as Atypical Presentation of Multiple Evanescent White Dot Syndrome: A Case
José Ignacio Vela1,2,3, Clément Jean Arthur Marie Passabosc1,3, José Antonio Buil Calvo1,3
1Ophthalmology Department, Hospital de la Santa Creu i de Sant Pau, Barcelona, Spain.
Abstract:
Classical clinical findings of multiple evanescent white dot syndrome (MEWDS) include multiple, small white dots scattered throughout the posterior pole, foveal granularity, posterior vitreous cells, and mild optic disc swelling. We describe the case of a 35-year-old man who was admitted to our department with an unusual presentation of MEWDS at the early onset of the disease. A unilateral circumpapillary retinal white spot was observed. Spectral domain optical coherence tomography demonstrated irregularities of the retinal pigment epithelium and disruptions of the outer retinal layers around the optic nerve without other abnormalities. A few days later, the lesion spread centrifugally from the peripapillary region and along the vascular arcades. This distinctive appearance in an early stage of the disease may suggest a disorder other than MEWDS, which can lead to a misdiagnosis and unnecessary treatment.
Insights
Multiple evanescent white dot syndrome (MEWDS) can present unusually with a peripapillary white spot. This early sign may mimic other conditions, potentially leading to misdiagnosis.
Area of Science:
- Ophthalmology
- Medical Imaging
- Retinal Diseases
Background:
- Multiple evanescent white dot syndrome (MEWDS) is an inflammatory eye condition.
- Typical MEWDS presents with specific clinical findings in the posterior pole.
Observation:
- A 35-year-old man presented with an atypical early manifestation of MEWDS.
- Initial observation revealed a unilateral circumpapillary retinal white spot.
Findings:
- Spectral domain optical coherence tomography showed retinal pigment epithelium irregularities and outer retinal disruptions near the optic nerve.
- The lesion subsequently spread centrifugally from the peripapillary region and along vascular arcades.
Implications:
- This unusual presentation can be mistaken for other disorders, risking misdiagnosis.
- Early recognition of atypical MEWDS is crucial to avoid unnecessary treatments.
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