Intriguing choroidal lesions in Birdshot chorioretinopathy: a diagnostic and clinical dilemma.

PURPOSE: To report a case of intriguing choroidal lesions in a patient with Birdshot chorioretinopathy. CASE PRESENTATION: A case report of a 51-year-old female with previous medical history of Birdshot chorioretinopathy presenting with de novo choroidal lesions, diffuse choroidal thickening and serous retinal detachment in the right eye is presented. Several medical evaluation visits were conducted, including ophthalmological and hematological follow-up. The multimodal imaging was suggestive of a lymphoproliferative process, presumably uveal lymphoid hyperplasia and the patient was referred to Hematology. A systemic work-up was conducted to rule out systemic malignancy and the choroidal biopsy was declined by the patient. The patient was treated with a short course of steroids due to an unrelated Bell's palsy, with complete resolution of the choroidal thickening and the neurosensory detachment. After a 4-year follow-up, the patient remained asymptomatic with no signs of relapse in the multimodal imaging. CONCLUSION: As underline by this case report, uveal lymphoid hyperplasia may be considered in patients with Birdshot chorioretinopathy, emphasizing the importance of individualized management and long-term follow-up in such complex clinical scenarios.