Leopard spot chorioretinopathy revealing late onset sympathetic ophthalmia

Abstract

AbstractPurposeTo report a case of a very late onset atypical sympathetic ophthalmia presented as a leopard spot retinopathy.MethodsAn observational case report of a 64‐year‐old patient with a history of penetrating ocular trauma of the right eye (RE) at the age of 3‐year‐old who presented with visual blurring of the left eye (LE). The patient underwent complete ophthalmic examination, autofluorescence imaging, fluorescein angiography, Indocyanine Green (ICG) angiography, swept‐source optical coherence tomography (SS‐OCT).ResultsExamination of the RE showed a phthisis bulbi. Visual acuity of the LE was limited to hand motion. Slit lamp examination revealed +1 cells anterior chamber inflammation, granulomatous keratic precipitates, posterior synechiae, with a mild cataract and +2 vitreous cells. Fundoscopy showed multiple yellowish patchy subretinal lesions. Fluorescein angiography revealed hyperfluorescent nummular areas at early frames without late leakage surrounded by zones of hypofluorescences. Fundus autofluorescence imaging showed a leopard spot pattern with areas of hypoautofluorescence surrounded by hyperautofluorescence. ICG angiography showed no hypofluorescent dark dots. SS‐OCT demonstrated retinal thickening, multiple areas of flat subretinal fluid, irregular hyperreflective spots at the photoreceptor outer segment layer and irregularities of the retinal pigment epithelium. The diagnosis of unilateral diffuse uveal melanocytic proliferation (DUMP) was first made. The patient underwent a systemic workup with full‐body computed tomography scans, cerebral and ocular magnetic resonance imaging and blood tests including tumor markers. All tests were normal. The patient was put on oral prednisone (1 mg/kg/day) during 6 months with a gradual tapering and good initial outcome. Visual acuity increased to 40/200.Two weeks after stopping steroids, he presented with acute granulomatous anterior uveitis and the diagnosis of very late onset sympathetic ophthalmia was made.ConclusionsLeopard retinopathy can be an uncommon clinical presentation of a variety of disorders especially sympathetic ophthalmia. The diagnosis could be challenging in case of atypical presentation and very late onset. Treatment outcome and close follow‐up should be considered for a correct diagnosis.