Isolated retinal astrocytic hamartoma masquerading as viral retinitis

A female in her early 50s presented with a yellowish-white retinal lesion with fluffy margins along with flame-shaped haemorrhages and cystoid macular oedema in the left eye. Due to a recent history of fever, a presumptive diagnosis of viral retinitis was made. Following no response to antiviral therapy, the patient underwent a revision of the diagnosis using multimodal imaging. Fundus fluorescein angiography and optical coherence tomography angiography (OCTA) revealed a dense vascular network in the lesion, suggestive of an isolated retinal astrocytic hamartoma (RAH). All ongoing treatment was stopped, and the patient was kept under observation. She was stable without any treatment at 1-year follow-up. This is an unusual case of isolated RAH without any systemic involvement, acting as a potential masquerade. Multimodal imaging, including OCTA, is diagnostic of RAH. This helps avoid unnecessary treatment with corticosteroids and antiviral therapy.