title: Importance of proper diagnosis for management: multifocal choroiditis mimicking ocular histoplasmosis syndrome.
abstract: OBJECTIVE
  The study aims to evaluate a series of patients with initial diagnosis of ocular histoplasmosis syndrome (OHS) with progression and response to treatments consistent with multifocal choroiditis (MFC).
  
  
  METHODS
  Retrospective review of nine patients referred for management of recurrent OHS lesions. Serology panel was conducted to rule out autoimmune and infectious causes.
  
  
  RESULTS
  Clinical examination revealed multiple small, punched-out peripheral chorioretinal scars, and peripapillary atrophy. Histoplasma antigen/antibody was negative in all patients. Fluorescein angiography and optical coherence tomography confirmed active inflammation in five patients. Immunomodulatory therapy (IMT) was initiated to control active inflammation. While on IMT, visual acuity stabilized or improved in three patients with no recurrence of CNV or lesion activities over the follow-up period.
  
  
  CONCLUSIONS
  MFC may initially masquerade as OHS. Clinical characteristics of recurrent MFC and absence of histoplasma titer may lead to consideration of IMT and other proper treatments for MFC.
authors.affiliation: Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street-Maumenee 745, Baltimore, MD, 21287, USA.
authors.forename: Elham
authors.initials: E
authors.lastname: Hatef
authors.forename: Peykan
authors.initials: P
authors.lastname: Turkcuoglu
authors.forename: Mohamed
authors.initials: M
authors.lastname: Ibrahim
authors.forename: Yasir
authors.initials: Y
authors.lastname: Sepah
authors.forename: Matthew
authors.initials: M
authors.lastname: Shulman
authors.forename: Jangwon
authors.initials: J
authors.lastname: Heo
authors.forename: Jeong Hee
authors.initials: JH
authors.lastname: Lee
authors.forename: Roomasa
authors.initials: R
authors.lastname: Channa
authors.forename: Afsheen
authors.initials: A
authors.lastname: Khwaja
authors.forename: Zubir
authors.initials: Z
authors.lastname: Rentiya
authors.forename: Syed Mahmood
authors.initials: SM
authors.lastname: Shah
authors.forename: Diana V
authors.initials: DV
authors.lastname: Do
authors.forename: Quan Dong
authors.initials: QD
authors.lastname: Nguyen