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Abstract:
In patients with multifocal choroiditis, presumed ocular histoplasmosis syndrome (POHS) is often diagnosed. However, POHS typically is not associated with inflammatory activity in the ocular media. A group of patients had a pattern of multifocal choroidal spots reminiscent of POHS with active signs of inflammation in the anterior and vitreous chambers. Of the 28 patients, 43% were black. In addition to inflammation, many patients had peripapillary atrophy (39%) or diskiform macular scars (32%). Of those with diskiform scars, 33% were black. Systemically, 32% of the patients were presumed to have sarcoidosis; 29%, tuberculosis; 11%, syphilis; and 28%, no etiology. In some cases, treatment of the underlying disease resulted in improvement of the ocular findings. Inflammatory pseudohistoplasmosis syndrome appears to be a nonspecific response to a number of uveitic syndromes, including sarcoidosis, tuberculosis, and syphilis.
Insights
Inflammatory pseudohistoplasmosis syndrome mimics presumed ocular histoplasmosis syndrome (POHS) but involves ocular inflammation. This condition can be a response to various uveitic syndromes, including sarcoidosis, tuberculosis, and syphilis.
Area of Science:
- Ophthalmology
- Immunology
Background:
- Multifocal choroiditis is often misdiagnosed as presumed ocular histoplasmosis syndrome (POHS).
- POHS typically lacks ocular inflammatory activity, distinguishing it from other uveitic conditions.
Purpose of the Study:
- To characterize a group of patients presenting with multifocal choroidal spots and active intraocular inflammation.
- To investigate the potential underlying etiologies of this inflammatory condition, termed inflammatory pseudohistoplasmosis syndrome.
Main Methods:
- Retrospective analysis of 28 patients with multifocal choroidal lesions and ocular inflammation.
- Systemic evaluation to identify potential underlying causes such as sarcoidosis, tuberculosis, and syphilis.
Main Results:
- 43% of patients were Black; 39% had peripapillary atrophy; 32% had diskiform macular scars.
- Identified systemic etiologies included sarcoidosis (32%), tuberculosis (29%), and syphilis (11%).
- Treatment of underlying systemic diseases led to improvement in ocular findings in some cases.
Conclusions:
- Inflammatory pseudohistoplasmosis syndrome is a nonspecific ocular inflammatory response.
- It can be associated with various uveitic syndromes, including sarcoidosis, tuberculosis, and syphilis.
- Accurate diagnosis and treatment of the underlying cause are crucial for managing this condition.