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JAMA Ophthalmology Clinical Challenge
June 2018

Uveal Mass, Uveitis, and Diffuse Rash in a Woman in Her 50s

Author Affiliations
  • 1Department of Ophthalmology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
  • 2Department of Ophthalmology, Western University, London, Ontario, Canada
JAMA Ophthalmol. 2018;136(6):704-705. doi:10.1001/jamaophthalmol.2017.5560

A woman in her early 50s with no ocular history presented with a 3-week history of pain and photophobia in her right eye. She had a 1-year history of bilateral intermittent paresthesia in her feet. She also reported a 3-month history of a bilateral, erythematous, purpuric macular rash originating on her lower extremities that spread superiorly to her abdomen and chest. She works in a barn, primarily with horses, and travels to Cuba frequently for humanitarian work.

On ocular examination, her visual acuity was 20/50 OD and the intraocular pressure was 16 mm Hg. She had 1+ cells in the anterior chamber and mild, fine keratic precipitates. Superotemporally, in the anterior chamber angle, a singular, smooth, yellow-gray mass was noted (Figure, A). As seen on ultrasonographic biomicroscopy, the mass originated in the ciliary body and protruded into the peripheral iris with minimal associated vasculature (Figure, B). The results of a posterior segment examination, including optical coherence tomography, were within reference limits. Examination results of the left eye were unremarkable.

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