Spotting the Diagnosis: A Case Report of Paraneoplastic Retinopathy Masquerading As White Dot Syndrome

This study aimed to report a rare case of presumed paraneoplastic retinopathy in a patient with multiple sclerosis who initially presented with clinical findings suggestive of white dot syndrome. This report describes a complex neuro-ophthalmic presentation where initial diagnostic considerations were reframed to reach the final diagnosis. A 46-year-old female with a past medical history of multiple sclerosis presented with progressively worsening vision in the left eye, a central blind spot, and visual disturbances. Initially, her symptoms were attributed to multiple sclerosis-associated optic neuritis or a white dot syndrome. However, the patient's atypical clinical course and lack of response to treatment broadened the differential diagnosis to include masquerade syndromes. The inconclusive results of a vitrectomy, worsening vision, new involvement of both eyes, and lack of response to traditional treatment ultimately led to a presumed diagnosis of paraneoplastic retinopathy. This case study informs ophthalmologists about ocular conditions with similar presentations and emphasizes the importance of maintaining a broad differential diagnosis, conducting diligent investigation, and engaging in multidisciplinary collaboration when faced with complex neuro-ophthalmic presentations.