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Multifocal choroiditis and panuveitis. A syndrome that mimics ocular histoplasmosis
Abstract:
A review of 28 cases of multifocal choroiditis with vitreous inflammatory cells demonstrates that these patients have chorioretinal scars similar to those in the presumed ocular histoplasmosis syndrome (POHS), but they have a low incidence of positive histoplasmin skin test reactions and calcified granulomata on chest x-ray films. Anterior chamber inflammation is a frequent finding. The epidemiologic background of these patients is different from those with POHS. The subjects in this study were also different from patients with birdshot or vitiliginous choroiditis and acute posterior multifocal placoid pigment epitheliopathy. However, unilateral cases are difficult to distinguish from cases of diffuse unilateral subacute neuroretinitis. While it is possible that a subretinal nematode may have caused some of the unilateral cases in this review, multiple causative agents are likely, including an unidentified agent that causes cross reactions to histoplasmin skin tests.
Insights
Multifocal choroiditis cases show scars resembling presumed ocular histoplasmosis syndrome (POHS) but differ in skin test reactions and epidemiology. Multiple causes are likely, potentially including an unidentified agent.
Area of Science:
- Ophthalmology
- Medical Retina
- Inflammatory Eye Disease
Background:
- Multifocal choroiditis (MFC) presents with chorioretinal scars.
- These scars are often compared to those seen in presumed ocular histoplasmosis syndrome (POHS).
- Distinguishing MFC from other posterior uveitides is clinically important.
Purpose of the Study:
- To review cases of multifocal choroiditis with vitreous inflammatory cells.
- To compare the clinical and epidemiological features of these patients with POHS and other similar conditions.
- To investigate potential causative agents for MFC.
Main Methods:
- Review of 28 cases of multifocal choroiditis with vitreous inflammatory cells.
- Analysis of clinical findings, including anterior chamber inflammation and chorioretinal scars.
- Evaluation of diagnostic tests such as histoplasmin skin tests and chest x-rays.
Main Results:
- Patients exhibited chorioretinal scars similar to POHS.
- Low incidence of positive histoplasmin skin tests and calcified granulomata on chest x-rays.
- Frequent anterior chamber inflammation and distinct epidemiological background compared to POHS.
Conclusions:
- MFC differs from POHS in key diagnostic markers and epidemiology.
- MFC is distinct from other conditions like birdshot choroiditis and acute posterior multifocal placoid pigment epitheliopathy.
- Unilateral cases may be challenging to differentiate, with potential for multiple etiologies including unidentified agents.