Rapidly progressing granulomatous retinochoroiditis with vasculitis: An extensive imaging and laboratory characterization of an unusual variant of sympathetic ophthalmia

A 36-year-old male suffered a traumatic open globe injury to his right eye resulting in phthisis. One year later, he developed a sudden progressive decrease in vision in the fellow (left) eye. Examination revealed arteriolar attenuation, multifocal deep subretinal infiltration, retinal edema, and necrosis. The patient underwent diagnostic vitrectomy in the left eye, and diagnostic enucleation of the phthisical right eye after suboptimal response to intravenous corticosteroid, antiviral, and antibiotic therapy. Detailed immuno-histopathological evaluation revealed extensive retinal disorganization with photoreceptor loss, perivascular infiltration, Dalen-Fuchs nodules, and granulomatous inflammation with central necrosis and melanin pigment, suggestive of a rare variant of sympathetic ophthalmia.