Serpiginous Choroidits

History of Present Illness

A 68-year-old man presents with 2-week history of painless unilateral loss of vision in the left eye (OS). He noticed a paracentral scotoma OS, and while hunting with a shotgun just realized that he has no central vision right eye (OD). He denies photophobia, photopsia, or floaters in either eye .

Questions to Ask

• Has your vision been tested within the past few years?

• What is your general health? Have you been diagnosed with a systemic disease?

• Have you had ocular trauma to either eye that required surgery or visit to an emergency room?

• Have you traveled to an area of the country with a history of fungal disease?

His visual acuity (VA) was not tested within the past few years, and he did not notice any visual problem until recently. He denies a history of a systemic or autoimmune disease. There is no history of ocular trauma to either eye that required surgery or a visit to an emergency room. He has lived in the Ohio Valley most of his life and occasionally traveled to the Southwest United States.

Assessment

• Chorioretinitis, remote OD and acute OS, unknown etiology

Differential Diagnosis

• Acute posterior multifocal placoid pigment epitheliopathy (APMPPE)

• Relentless placoid chorioretinitis

• Persistent placoid maculopathy

• Infectious retinitis (tuberculosis [TB], outer-layer retinal toxoplasmosis, syphilis)

• Presumed ocular histoplasmosis syndrome (POHS)

• Multifocal choroiditis (MFC)

• Sarcoid choroiditis