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Ophthalmic Images
August 13, 2015

Posterior Segment Findings in X-Linked Chronic Granulomatous Disease

Author Affiliations
  • 1Baylor College of Medicine, Houston, Texas
JAMA Ophthalmol. 2015;133(8):e151149. doi:10.1001/jamaophthalmol.2015.1149

X-linked chronic granulomatous disease (CGD) is an immunodeficiency disorder that affects phagocytes because of an abnormality in the NADPH oxidase system that is characterized by recurrent systemic infections with bacterial and fungal pathogens. Our patient presented with a visual acuity of 20/20 OU, normal anterior segment examination findings in each eye, and fundus examination findings as described (Figure). Family history of CGD had prompted a dihydrorhodamine flow cytometry test, which confirmed the diagnosis. This test indirectly measures reactive oxygen species levels, a byproduct of NADPH oxidase. Previous reports13 of patients with CGD have described chorioretinal lesions as hypopigmented, atrophic punched-out scars in a perivascular pattern and in the midequatorial region, sparing the macula. The lesions are seen in a few patients with CGD (12%-35%).24 The lesions are typically nonprogressive but may lead to decreased vision due to vitreous hemorrhage, neovascular membranes, and macular edema; therefore, routine examination is recommended.3,4 The cause of the posterior segment lesions remains unclear.13

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