Title

EXUDATIVE RETINOPATHY ASSOCIATED WITH SYSTEMIC DISORDERS: CHALLENGE IN DIFFERENTIAL DIAGNOSIS

Summary

Purpose: To describe a case of unilateral exudative retinopathy associated with systemic conditions. Case Presentation: A 7-year-old girl undergoing chemotherapy maintenance for T-cell lymphoblastic lymphoma presented with a 3-year-history of left exotropy. On examination, her visual acuity was 20/20 in the right eye (RE) and <20/400 in the left eye (LE). Slit-lamp examination was unremarkable and no vitreous cells were noted. Fundus examination revealed a fibrotic foveal nodule with surrounding exudates and temporal peripheral retinal vessel telangiectasia with exudation in LE. Fluorescein angiography demonstrated unilateral telangiectasic vessels, aneurysmal dilatations and capillary non-perfusion. On optical coherence tomography, macular scanning showed a subfoveal nodule in LE. After systemic work-up, including infectious screening, cerebral spinal fluid analysis and imaging exams, no evidence of neoplasic central nervous system (CNS) involvement was noted. On the other hand, a reactive tuberculin skin test was obtained (15 mm), without signs of active disease. Discussion: Hypotheses of intraocular lymphoma, tuberculosis-related vasculitis and Coats Disease were raised. However, some factors, such as age, absence of CNS invasion, and T-cell line weaken the hypothesis of intraocular lymphoma. Similarly, the absence of vitreitis and lack of choroidal involvement also counteract intraocular tuberculosis. Therefore, diagnosis of Coats Disease (Stage 2B) was made. Although it is less common in female sex, it is the most plausible hypothesis due to unilateral peculiar characteristics (telangiectasia, exudation and subfoveal nodule). As noted, it can be incidentally associated with systemic disorders. Due to low visual prognosis, it was opted for clinical monitoring in this case.

Area

CLINICAL CASE

Authors

Lívia da Silva Conci, Sergio Gianotti Pimentel, Cleide Guimarães Machado, Leandro Cabral Zacharias, Tomás Minelli, Livia Garcia Biselli, Felipe Ribeiro de Souza, Renato Rodrigues Pereima