Author: Ricardo Machado Soares (Portugal)
Co-authors: Joana Da Silva Fernandes, Catarina Cunha Ferreira, Lígia Ribeiro, Sofia Cunha Fonseca
Purpose
To report a case initially diagnosed as an acute central serous chorioretinopathy (CSCR) which turned out to be choroidal metastases from Renal Cell Carcinoma.
Setting/Venue
Department of Ophthalmology - Centro Hospitalar de Vila Nova de Gaia e Espinho - Portugal
Methods
Case report based on clinical history, ophthalmologic evaluation (visual acuity, slit-lamp examination, and indirect ophthalmoscopy), and findings on ancillary exams [retinography, optical coherence tomography (OCT), chest x-ray, and brain and thoracic-abdominal-pelvic computerized tomography (CT)].
Results
A 58-year-old male, with a history of smoking and arterial hypertension, presented to the Ophthalmology emergency department with acute decreased visual acuity (VA) and central scotoma in his left eye (OS). On exam, VA was 20/200 in the OS, and fundoscopy revealed an oval serous macular detachment (6.5x5.4 mm) without hemorrhages or sub-retinal deposits (confirmed by OCT). A presumptive diagnosis of acute CSCR was established and an appointment was scheduled. Fluorescein angiography showed two oval hyporeflective areas (one macular and a smaller one superior to the disk) corresponding to the subretinal detachments. No leakage points could be identified. Twenty-five days after the initial diagnosis, the patient was admitted to the emergency ward with complaints of cough and malaise. Brain and thoracic-abdominal-pelvic CT scan revealed multiple lesions in the lungs, brain, and kidney. A kidney biopsy was performed and its histological examination revealed a grade 3 clear cell renal carcinoma. On ophthalmologic re-evaluation, indirect ophthalmoscopy revealed a full 360º serous retinal detachment and optic disc edema. A diagnosis of metastasized (brain, lung, and choroid) Renal cell carcinoma was established.
Conlusions
Choroidal metastases may mimic acute CSRC, especially If detected early. Practitioners need to be aware of these diseases to prevent possible misdiagnosis.
Financial Disclosure
None
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