Serpiginous Choroiditis Case Study

This 45-year-old female patient presented with complaints of an inferotemporal scotoma in the left eye of 13 days duration (Amsler grid shown in panel A, red arrow). Her vision in right eye was 20/16 and 20/20 in left eye. Intraocular pressures were 12 right eye and 11 left eye. Anterior Exam findings were all normal. Fundus exam was normal macula on the right (panel B). The left fundus showed a deep retinal peripapillary lesion (panel C, black arrow). Fundus autofluorescence imaging showed hyperautofluorescence in the center of the lesion with a hypoautofluorescent border (panel D, yellow arrows). By near infrared reflectance imaging (panel E, en face view), the lesion was hyperrefective. On spectral domain optical coherence tomography (panel E, right side), the lesion featured loss of photoreceptors and retinal pigment epithelium (blue arrow). The patient was given an injection of posterior subtenons triamcinolone acutely with a plan to begin immunomodulating therapy once screening laboratories confirm absence of tuberculosis.