INSTRUCTION

Examine this patient's fundus.

SALIENT FEATURES

History

· Decreased vision, floaters, red eye.

· History of HIV, sarcoidosis, TB.

Examination

· Old or inactive retinochoroiditis appears as white, well-defined areas of

chorio-retinal atrophy with pigmented edges (due to proliferation of retinal pigment

epithelium).

· The retinal blood vessels pass over the lesions undisturbed.

DIAGNOSIS

This patient has areas of retinal atrophy with pigmented edges (lesion) due to old

choroiditis complicating cytomegalovirus infection (aetiology).

QUESTIONS

What may be the aetiology?

· Reactivation of congenital toxoplasmosis.

· Cytomegalovirus infection.

· AIDS.

· Sarcoidosis.

· TB.

· Syphilis.

· Behget's disease.

What is the prognosis?

Prognosis varies according to the underlying aetiology. It is poor if the fovea is involved.

What does the presence of pigment on fundoscopy indicate?

A chronic lesion of the retina or choroid.

In which other conditions is the retinal pigment seen?

· Normally - racial (tigroid fundus).

· Retinitis pigmentosa.

· Malignant melanoma.

H. Behcet (1889-1940), Professor of Dermatology in Turkey, described this syndrome in

1937, based on three patients he observed between 1924 and 1936.