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Manfred Zierhut Centre of Ophthalmology University of Tuebingen, Germany

Masquerade Syndrome. Manfred Zierhut Centre of Ophthalmology University of Tuebingen, Germany. Refering Letter – Ocular History. 30 year old female white patient March 2004: OU „ therapy-resistant chorioretinitis“ 2004: 10 days hospitalized at a department of Ophthalmology.

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Manfred Zierhut Centre of Ophthalmology University of Tuebingen, Germany

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  1. Masquerade Syndrome Manfred Zierhut CentreofOphthalmology University of Tuebingen, Germany

  2. Refering Letter – OcularHistory • 30 yearoldfemalewhitepatient • March 2004: • OU „therapy-resistant chorioretinitis“ • 2004: • 10 dayshospitalized at a departmentofOphthalmology

  3. Refering Letter – OcularExamination • VA: OU 1.0, • anteriorsegment: OU: regular • fundus: • OD: opticdisc vital, chorioretinal infiltrations at theupperandlowervesselarc, withoutactivity, macularegular • OS: lessinfiltrations, noactivity, macularegular

  4. PreviousDiagnostics • routinelab: unremarkable • ESR: 19/38mm • proteinelectrophoresis: α2- and ß-globuline minimallyabovethe normal range • ACE normal, ANA negative • hepatitis-B andhepatitis-C negative • HIV 1 and 2 negative • CMV, Picorna/ECHO, VZV, measlesvirus, mumpsvirus, HSV 1 and 2, FSME virus, coxsackievirus: nosignsforactiveinfection

  5. PreviousDiagnostics • Candida albicans serology: negative • Toxocara canis serology: negative • Toxoplasma gondii serology: negative • Yersinien-Serology: nosignforacuteinfection • Lymediseaseserology: nosignforacuteinfection • Lues-serology: negative • Anti-Streptolysin O: negative • HLA B 27 positiv, HLA DR11, DR17

  6. Refering Letter • „Undertreatment with oral prednisolone at thehospitalreductionofthesizeofthelesions, with betterdemarcation“ • „Duringclose follow upsagainmore chorioretinal lesions after reductionofthecorticosteroids“ • rheumatologistsuggestedadditionallyazathioprine (since 3-2004)

  7. First Presentation – OcularExamination • Since6 weekswhitespots in botheyes, espduringwork on thecomputer, since 3 weekselevatedbloodpressuredetected (170/90mmHg) • Ocularhistory: CL sincetheageof 18, foreignbodyinjury (?)

  8. First Presentation – OcularExamination • VA OU 1.0, • IOP: OU 18mmHg • Anteriorsegment: OU noendothelialprecipitates, no AC cells, pupilround, lensclear, mild vitreousbodydestruction, but novitreoscells

  9. First Presentation – General History • sakroileitis

  10. First PresentationTreatment at thismoment • Prednisolon 15mg, • Azathioprine 100mg

  11. First Presentation – OcularExaminationFundus OD • opticdisc with mild edema nasally, vital • macula dry • whiteretinalinfiltrationsaroundthevesselarcs • narrowarteries, tortuositas ofthevessels • sizevariationsofthe venes • crossingsigns • mild retinalpointbleedings • regularperiphery

  12. First Presentation – OcularExaminationFundus OS • opticdisc with cleardemarcation, vital, slightlyhyperemic • macula dry • whiteretinalinfiltrationsaroundthevesselarcs • narrowarteries, tortuositas ofthevessels • sizevariationsofthe venes • crossingsigns • mild retinalpointbleedings • regularperiphery

  13. First Presentation – Fundus OS

  14. Diagnosis • HypertensiveRetinopathy • based on • clinicalfindings • courseofthedisease • missingresponseto anti-inflammatorytreatment • in addition: HLA-B27 positive ankylosing spondylitiswithoutuveitis

  15. Conclusion • retinopathyofarterialhypertensionmaylook like uveitisforthefirstview • cottonwoolspotsarehighlytypical • nocellularinfiltrationofthevitreousoranteriorchamberaredetectable • highlyimportanttodifferentiatethelayeroflesions: retinalvs chorioretinal • toomuch lab investigationdoes not clarifythesituation, mayevenleadto a wrongdiagnosis

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