Maurice F. Rabb » Granulomatous Choroiditis

Twelve year old Asian girl with strong allergic history, first seen by me (HS) in September 1975. History revealed: 1973 (age 10) scleritis in right eye, cleared with steroid drops. A few months later developed iritis in the left eye, cleared with steroid drops. Each diagnosis (scleritis right eye and iritis left eye) was confirmed by the University of California Uveitis Group (Kimura, et al).

In 1974 (age 11) she developed in the right eye iritis with blurred vision and "edema of the posterior pole and striae in the macula." In the left eye a "salmon-type" lesion was seen superotemporal to the disc as well as "edema of the posterior pole." The vision in the right eye dropped to 20/200; a central scotoma was found. The patient was thoroughly worked up by the Uveitis Group: revealed nothing but an elevated alkaline phosphatase. Spinal tap revealed ten lympocytes.

At my (HS) first exam in September 1975, she had been on 60mg of Prednisone a day for a few weeks. The vision measured 20/30 and J 1 in each eye. Normal intraocular pressure and normal eye exam except for optic nerve edema and a red choroidal lesion in the left fundus (see photos). I made diagnosis of granulomatous choroiditis and suggested laboratory work-up. I had her start weaning off of systemic steroids. Three months later, December 1975, the patient returned and was not quite off steroids, yet. Vision 20/20 in each eye. Two new satelite lesions were seen in the left eye, one superonasal and one superotemporal to the macula. I suggested remove systemic steroids and give retrobulbar steroids - this was given by her referring ophthalmologist, subtenons. One month later, January 1976, vision in each eye 20/20. Left eye optic nerve inflammation was worse. Retrobulbar steroids repeated. At this point the patient was lost to follow-up.

In 1977, at our fluorescein club meeting one of our members presented a choroidal osteoma. When I got back to San Francisco I called the patient back and she was able to return the next spring April 1978. Vision, 20/20 in each eye. The lesion superotemporal to the disc had become confluent with the satelite lesion superotemporal to the macula. Photos and angiography done. Ultrasonography was donw, looking for bone: none was found. Orbital tomography: no calcium or bone found. Patient followed.

September 1978, lesion the same. July 1979, ultrasound repeated, no bone. Patient seen April 1980, the lesion had gotten bigger, vision was still 20/20 in each eye. The patient was on no medicines and had not had an episode of intraocular inflammation in either eye for approximately four years. Ultrasonography was repeated.