Levine Emily S, Mendonça Luísa S M, Baumal Caroline R, Chin Adam T, Rifkin Lana, Waheed Nadia K
New England Eye Center, Tufts Medical Center, Boston, MA, USA.
Tufts University School of Medicine, Boston, MA, USA.
Am J Ophthalmol Case Rep. 2020 Sep 25;20:100944. doi: 10.1016/j.ajoc.2020.100944. eCollection 2020 Dec.
To report a case of presumed ocular sarcoidosis initially presenting with features of multiple evanescent white dot syndrome (MEWDS) with atypical optical coherence tomography angiography (OCTA) findings.
A 23 year-old woman presented with a unilateral central scotoma, photophobia, and decreased visual acuity after a viral illness. Examination of the right eye revealed multiple round white macular spots and stippled granularity at the fovea. Multimodal imaging with fluorescein angiography (FA), indocyanine green angiography (ICG), fundus autofluorescence (FAF), and optical coherence tomography (OCT) was consistent with a diagnosis of MEWDS. However, OCTA demonstrated choriocapillaris (CC) flow deficits, which is not typical for MEWDS. The clinical course was initially consistent with MEWDS, with spontaneous recovery of symptoms over ensuing months. The patient presented five months later with floaters and a central scotoma. Examination showed panuveitis, and systemic evaluation revealed an elevated angiotensin converting enzyme (ACE) and hilar lymphadenopathy on chest x-ray consistent with presumed sarcoidosis.
A case of MEWDS atypically demonstrated CC flow deficits on OCTA and subsequently presented as uveitis secondary to presumed sarcoidosis. Atypical features in MEWDS may be a sign of another disorder masquerading early on as MEWDS and ought to prompt further investigation.
报告一例疑似眼部结节病病例，该病例最初表现为多发性一过性白点综合征（MEWDS）的特征，并伴有非典型光学相干断层扫描血管造影（OCTA）表现。
一名23岁女性在病毒感染后出现单侧中心暗点、畏光和视力下降。右眼检查发现多个圆形白色黄斑斑点以及黄斑中心凹处有斑点状颗粒。荧光素血管造影（FA）、吲哚菁绿血管造影（ICG）、眼底自发荧光（FAF）和光学相干断层扫描（OCT）的多模态成像结果与MEWDS的诊断一致。然而，OCTA显示脉络膜毛细血管（CC）血流缺损，这在MEWDS中并不典型。临床过程最初与MEWDS相符，症状在随后几个月内自发缓解。患者五个月后出现飞蚊症和中心暗点。检查显示全葡萄膜炎，全身评估发现血管紧张素转换酶（ACE）升高，胸部X线显示肺门淋巴结肿大，符合疑似结节病的表现。
一例MEWDS在OCTA上非典型地显示CC血流缺损，随后表现为疑似结节病继发的葡萄膜炎。MEWDS中的非典型特征可能是另一种疾病早期伪装成MEWDS的迹象，应促使进一步检查。
