A white man in his early 80s with history of autoimmune pancreatitis, recurrent colon polyps, and benign prostatic hyperplasia developed rapid, painless vision loss of both eyes over a 2-week period 6 months after cataract surgery. Vision was 20/250 OD and 20/60 OS. The anterior segment was unremarkable in either eye, while the posterior segment examination noted 1+ vitreous cell, asteroid hyalosis, and a multilobulated, serous retinal detachment (RD) in the right eye and trace vitreous cell and a multilobulated, serous RD in the left eye. Imaging included B-scan, optical coherence tomography, and fundus autofluorescence, which revealed diffuse choroidal and ciliary body thickening, multifocal pockets of subretinal fluid, and speckled hyperautofluorescence and hypoautofluorescence in both eyes (Figure 1). No poliosis or skin changes were noted. A review of systems was unremarkable, most notably a lack of any pulmonary symptoms. A focused laboratory evaluation identified a significantly elevated angiotensin-converting enzyme (ACE) level and antinuclear antibody titer, but serum lysozyme, syphilis, and tuberculosis testing had negative results. To better differentiate between Vogt-Koyanagi-Harada (VKH) syndrome, a lymphoproliferative disorder, or sarcoidosis as the underlying cause of the vitreous inflammation and multilobulated, serous RD in both eyes, a computed tomographic scan was performed. It showed marked lymphadenopathy throughout the mediastinum and diffuse scleral thickening in both eyes. The institute’s radiologists believed these computed tomography findings were nonspecific and could be indicative of either sarcoidosis or intraocular lymphoma.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Christopher D. Conrady, MD, PhD, Department of Ophthalmology, Pathology/Microbiology, University of Nebraska Medical Center, 3902 Leavenworth St, Omaha, NE 68105 (firstname.lastname@example.org).
Published Online: February 17, 2022. doi:10.1001/jamaophthalmol.2021.5241
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information. We thank Hakan Demirci, MD, and Victor Elner, MD, University of Michigan, for their help with this difficult case.
Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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