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June 2008

Granulomatous Posterior Uveitis
Written by Annie C. Lee, MD, Michael P. Kelly, CPT, and Prithvi Mruthyunjaya, MD, Duke University Eye Center, Durham, N.C. 

A 24-year-old man of Mexican descent presented with photophobia, redness and a progressive decline in vision the left eye over the previous eight days. Posterior examination revealed a white subretinal lesion of one disc diameter and a superficial intraretinal hemorrhage.

OCT confirmed an adjacent serous macular detachment where the foveal thickness measured 766 µm. Edema was present contiguous to the lesion inferonasally, while perivascular sheathing was seen for 360 degrees, with regions of arteriolar occlusion. Fluorescein angiography also revealed markedly delayed inferior arterial filling and perivascular leakage. In the macula, the lesion demonstrated early central hypofluorescence and late leakage along the borders.

Work-up included normal chest x-ray, CBC, ACE and Toxoplasma IgG and IgM titers. The patient was negative for HIV Ab and nonreactive to syphilis serology. A PPD with controls was placed but not read, since the patient was lost to follow-up.

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