Bilateral Multifocal Choroiditis in Polymyositis: A Case Report and Review of the Literature

PURPOSE: To describe a case of bilateral multifocal choroiditis without retinitis or retinal vasculitis in the setting of acute polymyositis. METHODS: Review of medical records with multi-modal imaging and review of literature. RESULTS: A 45-year-old male presented with progressive extremity weakness and myalgias, followed by significant vision loss of both eyes. Examination during the acute inflammatory phase showed posterior inflammatory stigmata without anterior segment involvement. Fluorescein angiography showed papillitis, and macular leakage with progression to multifocal macular scarring. Optical coherence tomography (OCT) showed attenuation of the photoreceptor and retinal pigment epithelium (RPE) layers. Muscle biopsy demonstrated polymyositis and infectious workup was negative. Recovery of visual acuity and near complete restoration of the photoreceptor layer occurred with systemic immunosuppression. CONCLUSION: Ophthalmic manifestations of polymyositis may include posterior uveitis without retinal vasculitis. This association is rare in the literature to date.