First Author: I.Yago SPAIN
Co Author(s): J.M. Marin A. Minguez 0 0 0 0 0 0 0 0 0
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To report a case of a 3-year-old child with choroiditis complicated by subfoveal choroidal neovascularization (CNV) and two possible differential diagnoses.
Choroidal neovascularisation (CNV) is a rare but important cause of visual impairment in children frequently associated with an inflammatory origin.
A 3-year-old boy was referred to our clinic for a suspected ocular toxoplasmosis in his right eye found during routine ophthalmologic examination.
On exam, his best-corrected visual acuity was counting fingers in the right eye and 20/20 in the left eye. Extraocular motility, confrontational visual fields and anterior segment examination were within normal limits in both eyes (OU). Fundus examination demonstrated peripapillar atrophy in OU, a yuxtapapillar CNV in his right eye (OD) with a surrounding area of RPE changes affecting the macula. Multiple small white choriorretinal scars were located in the periferal retina of both eyes. No vitritis or vasculitis were detected. Fluorescein angiography showed early hyperfluorescence of the NVC followed by late staining of the lesion. Optical coherence tomography (OCT) showed a well-circumscribed elevated lesion with no subretinal or intrarretinal fluid. OCT of the macula revealed a foveal atrophy in the OD. Six months after the first examination the lesion remained stable and observation was decided.
Presumed ocular histoplasmosis syndrome (POHS) and multifocal choroiditis with panuveitis (MFC) have many similarities, with visual loss generally resulting from choroidal neovascularization. In the absence of active inflammation, the choriorretinal scarring of these diseases is similar and the differential diagnosis is essential as it may influence the treatment and prognosis. Our patient's clinical stability, the absence of inflammatory sequelae and the association with certain HLA have been the clues to the diagnosis of POHS.