Old choroiditis

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 22/04/2025

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208 Old choroiditis

Instruction

Examine this patient’s fundus.

Salient features

History

• Decreased vision, floaters, red eye

• History of HIV, sarcoidosis, TB.

Examination

• Old or inactive retinochoroiditis appears as white, well-defined areas of chorioretinal atrophy with pigmented edges (caused by proliferation of retinal pigment epithelium) (Fig. 208.1B)

• The retinal blood vessels pass over the lesions undisturbed.

image

Fig. 208.1 Toxoplasmic chorioretinitis. (A) Active chorioretinitis with two lesions and vitreous haze in HIV infection. (B) Large inactive macular lesion typical of congenital disease. (C) Active chorioretinitis in an immunocompetent patient showing an inactive lesion on the right and the macular star, which is caused by an exudate around the macula.

(With permission from Mandell et al. 2009.)

Diagnosis

This patient has areas of retinal atrophy with pigmented edges (lesion) caused by old choroiditis complicating cytomegalovirus infection (aetiology).

Questions

What may be the aetiology?

• Reactivation of congenital toxoplasmosis

• Cytomegalovirus infection

• HIV infection (Fig. 208.1A)

• Sarcoidosis

• TB

• Syphilis

• Behçet’s disease.

What is the prognosis?

Prognosis varies according to the underlying aetiology. It is poor if the fovea is involved.

What does the presence of pigment on fundoscopy indicate?

A chronic lesion of the retina or choroid.

In which other conditions is the retinal pigment seen?

• Normally: racial (tigroid fundus)

• Retinitis pigmentosa

• Malignant melanoma.

H Behçet (1889–1940), Professor of Dermatology in Turkey, described this syndrome in 1937 based on three patients he observed between 1924 and 1936.

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208 Old choroiditis

Instruction

Examine this patient’s fundus.

Salient features

History

• Decreased vision, floaters, red eye

• History of HIV, sarcoidosis, TB.

Examination

• Old or inactive retinochoroiditis appears as white, well-defined areas of chorioretinal atrophy with pigmented edges (caused by proliferation of retinal pigment epithelium) (Fig. 208.1B)

• The retinal blood vessels pass over the lesions undisturbed.

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