A 45-YEAR-OLD black woman with human immunodeficiency virus was evaluated for slowly decreasing vision in her left eye for 2 months. Findings from systemic review included a persistent cough and night sweats for 3 months. At initial examination, she had a visual acuity of 20/20 OD and counting fingers OS. Findings from the anterior segment and vitreous examination were normal in both eyes. Results of a posterior segment examination of the left eye revealed a 5 × 5-mm white choroidal lesion that was 3.5-mm thick by B-scan ultrasonography (acoustically dense, high internal reflectivity, and no choroidal excavation) (Figure 1). Fluorescein angiography demonstrated early blockage and late staining of the lesion (Figure 2 and Figure 3).
B-scan ultrasonogram of the left eye showing an acoustically dense choroidal lesion with no choroidal excavation.
Fluorescein angiogram in the early venous phase showing early blockage at the edges of the lesion and early hyperfluorescence within the central aspect of the choroidal lesion; the overlying retinal vessels are normal and in focus. The other retinal vessels are not in focus secondary to the thickness of the lesion.
Fluorescein angiogram in the late phase revealing late staining of the choroidal lesion.
Fundus photograph showing a white choroidal lesion causing the fovea to be ectopic.
Fundus photograph of the left eye showing resolution of the choroidal tubercle with retinal pigment epithelium stippling within the resolving choroidal tubercle.
B-scan ultrasonogram showing an acoustically dense choroidal lesion that is much smaller than prior to treatment and is approximately 1½ mm in thickness; the crosses show the anterior and posterior extent of the lesion.
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