White dot syndrome in a patient with presumed ocular tuberculosis: a case report

Zaira Fernanda Martinho Nicolau; Diego Lisboa Araújo; Luis Filipe Nakayama; Vinicius Campos Bergamo; Rodrigo Luz Meirelles; Octaviano Magalhães Júnior

doi:10.1186/s40942-022-00372-6

White dot syndrome in a patient with presumed ocular tuberculosis: a case report

Int J Retina Vitreous. 2022 Apr 5;8(1):25. doi: 10.1186/s40942-022-00372-6.

Authors

Zaira Fernanda Martinho Nicolau¹, Diego Lisboa Araújo², Luis Filipe Nakayama², Vinicius Campos Bergamo², Rodrigo Luz Meirelles², Octaviano Magalhães Júnior²

Affiliations

¹ Department of Ophthalmology, Universidade Federal de São Paulo-Escola Paulista de Medicina-São Paulo (SP), Botucatu st., 806. Vila Clementino, São Paulo, 04023-062, Brazil. zairanicolau@hotmail.com.
² Department of Ophthalmology, Universidade Federal de São Paulo-Escola Paulista de Medicina-São Paulo (SP), Botucatu st., 806. Vila Clementino, São Paulo, 04023-062, Brazil.

Abstract

Background: This manuscript describes a case of a patient with presumed ocular tuberculosis masquerading as multiple evanescent white dot syndrome.

Case presentation: A 32-year-old male patient presented with a complaint of reduced visual acuity in the left eye. Retinal fundus exam of the left eye revealed gray-whitish deep lesions predominantly nasal to the optic disc. The lesions were more clearly identifiable on fundus autofluorescence (FAF) imaging, fluorescein angiography (FA) and en face optical coherence tomography (OCT). FA also indicated retinal vasculitis and papillitis. Swept-source OCT B-scan demonstrated loss of the ellipsoid layer in the regions corresponding to the lesions detected by FAF. A positive tuberculin skin test (TST) confirmed presumed tuberculosis, and a related WDS diagnosis was made. Specific antituberculosis therapy was instituted with favorable anatomical recovery and visual outcome.

Conclusion: Multiple evanescent white dot syndrome (MEWDS) may be manifestation of presumed ocular tuberculosis, and multimodal retinal exams can provide a better understanding of atypical diseases and their follow-up.

Keywords: Multiple evanescent white dot syndrome; Tuberculosis; White dot syndrome.