DUSN

Abstract

A 49-year-old male presents with decreased vision in the right eye. Figure 1: Color photo montage of the right eye. Note the optic disc pallor, attenuated retinal arterioles, areas of retinal whitening in the nasal and peripapillary macula, sub-and parafoveal fibrotic changes, and diffuse RPE atrophy. Case History A 49-year-old Latino male presented with the complaint of decreased vision in the right eye for 2 months. Past ocular history was notable for retinochoroiditis of unclear etiology in the right eye, and prior work up performed elsewhere had included negative QuatiFERON-TB Gold test, non-reactive rapid plasma reagin test, and normal complete blood count. Upon presentation, he was taking 80 mg per day oral prednisone for ocular inflammation. Past medical history was unremarkable aside from systemic hypertension, treated with lisinopril. Family history was non-contributory. Upon review of systems the patient said he had experienced diffuse urticaria 1 month prior to presentation. Occupational history included current work as a tree-trimmer in Northern California. On examination, visual acuity was hand motions in the right eye and 20/16 in the left eye. There was an afferent pupillary defect in the right eye. Ocular motility, intraocular pressure, and anterior segment examinations were normal in both eyes. The posterior segment examination of the right eye revealed moderate vitritis, optic disc pallor, attenuated retinal vessels, areas of retinal whitening in the nasal macula, and diffuse retinal pigment epithelium (RPE) atrophy (Figure 1). Dilated examination of the left fundus was unremarkable. Wide-field fundus autofluorescence of the right eye showed diffuse mottled hyper-and hypoautofluorescence predominantly in the posterior pole (Figure 2), and widefield fluorescein angiography revealed extensive