Atlantic Coast Retina Club 2022 Part 3: Nematodes, SFU, Amyloid, Bietti’s, and Toxo

Blake Fortes
Mayo Clinic

We continue coverage of the 2020 Atlantic Coast Retina Club, hosted this year in Philadelphia.

Dr. Karen Wai presented a fascinating case of a 29-year-old male with paranoid schizophrenia who presented with a hypopyon and white cataract in the right eye. The patient underwent intravitreal tap and injection of antibiotics for presumed endophthalmitis followed by pars plana vitrectomy and lensectomy after minimal response to the injections. On the calcofluor white stain from the aqueous sample, a nematode was identified. The infectious organism was later classified as ocular toxocariasis and the patient was subsequently treated with albendazole and oral prednisone. It came out through further history that the patient routinely drank muddy water on the streets of Boston which was felt to be the source of his infection.

Dr. Marisa Tieger then presented an excellent case of a 17-year-old male with panuveitis and subretinal fibrosis syndrome with impressive imaging findings that slowly progressed over many years. It took many years for the diagnosis to be made as the patient was originally diagnosed with acute idiopathic blind spot enlargement, but when the retina findings appeared, the diagnosis of subretinal fibrosis and uveitis was made after negative systemic workup.

Dr. Jose Davila presented a case of familial transthyretin amyloidosis with characteristic stalagmite-like retinal deposits on OCT. Excellent commentary from the audience said these findings are nearly pathognomonic for amyloid.

Dr. Mark Travor then presented a case of submacular methicillin-resistant staphylococcus aureus choroidal abscess in a 14-year-old male with a history of pre-B-cell acute lymphoblastic leukemia who underwent inductive chemotherapy. Dr. Anand Gopal presented a classic case of Bietti crystalline retinopathy in a 27-year-old male with numerous yellow-white retinal crystals. Upon examination of the cornea, the diagnosis was clinched upon finding perilimbal corneal crystals.

Dr. Michael Ammar presented an interesting case of ocular toxoplasmosis and presumed toxoplasmosis cardiomyopathy. The patient initially presented with an extensive exudative retinal detachment with subtle macular whitening, dense vitritis, and segmented appearance of the vasculature. The patient was treated with intravitreal clindamycin, systemic trimethoprim-sulfamethoxazole, and corticosteroids with resolution of his ocular findings and stabilization of his vision. An extensive previous workup for his cardiomyopathy was negative and the patient was in the process of joining the heart transplant list, however, after initiation of his Bactrim, his ejection fraction returned to normal and his cardiomyopathy was essentially cured. A truly life saving diagnosis.

Dr. Louie Cai presented a rare case of DYRK1A syndrome, which had similar findings to familial exudative vitreoretinopathy with negative genetic testing on a FEVR panel, adding a new mutation to consider in patients with a FEVR-like phenotype.

Dr. John Hinkle presented a rare case of unilateral periphlebitis, and a massive contralateral sub-conjunctival lesion which was subsequently diagnosed upon conjunctival biopsy as diffuse large B-cell lymphoma. Dr. Carol Shields commented that these findings often portend poor prognosis and unfortunately Dr. Hinkle’s patient passed 8 months after diagnosis. The session concluded

And finally, Dr. Linnet Rodriguez presented an excellent case of tubulointerstitial nephritis and uveitis syndrome in a 45-year-old male with anterior uveitis and renal impairment that was diagnosed after renal biopsy.

Please read on for the final post covering Atlantic Coast Retina Club.