A young adult presented with diminished vision. On examination he has anterior uveitis, vitritis, focal necrotizing granuloma, and macular spot. What is the most probable diagnosis?
Ans is 'd' i.e. Ocular toxoplasmosisFocal necrotizing granuloma in this question suggests that it may be a case of ocular toxoplasmosis.In ocular toxoplasmosis the most common lesion is the focal necrotizing retinitis and necrotizing granuloma. Presence of macular spot is suggestive of old healed lesion that occurs most commonly in macular area. New lesion or reactivation of the lesion occurs most commonly at the edge of the old lesions. Intense vitritis may be found in ocular toxoplasmosis (remember head light in fog presentation of ocular toxoplasmosis). Anterior uveitis is also found in eyes with posterior segment lesions and usually results from the spillover of inflammation from the posterior segment.In multifocal choroiditis, granulomatous lesions are not found, although multifocal choroiditis may be of tubercular origin. But in other variants of tubercular involvement of the eye granuloma is found. Also vitritis is an uncommon feature of multifocal choroiditis and the lesions are multifocal instead of focal.White dot syndrome is not a single disease entity but it is a group of disorders comprise of various inflammatory clinical entities which present with multiple white dots at the posterior pole or segment of the eye. Multifocal choroiditis is also one of the entities included in white dot syndromes. Other common disorders included are acute posterior multifocal placoid pigment epitheliopathy (APMPPE), Birdshot retino choroidopathy, punctuate inner choroidopathy (PIC), serpiginous choroidopathy, multiple evanescent white dot syndrome (MEWDS). Obviously, dots are multiple (multifocal rather than focal).Proteus syndrome (PS) is a rare congenital condition that can be loosely categorized as a hamartomatous disorder. It is a complex disorder with multisystem involvement and great clinical variability. This condition is characterized by various cutaneous and subcutaneous lesions, including vascular malformations, lipomas, hyperpigmentation, and several types of nevi. Partial gigantism with limb or digital overgrowth is pathognomonic, with an unusual body habitus and, often, cerebriform thickening of the soles of the feet. Because cutaneous lesions tend to appear over time, the diagnosis may be delayed until late infancy, childhood, or even adulthood. Orthopedic complications often pose the most challenging medical problems, although vascular complications also contribute to overall morbidity. Eye involvement has been reported in some variants of PS. They are usually conjunctival capillary hemangioma, macrophthalmia with severe aniso myopia with hemihypertrophy. Optic nerve malformation (coloboma) and ocular deviations (squint) and amblyopia are also found in these cases.
Proteus syndrome
White dot syndrome
Multifocal choroiditis
Ocular toxoplasmosis
Ocular Manifestations