The patient is a 38-year-old female. On October 3, 2023, She was admitted to the ophthalmology clinic of our hospital due to "blurred vision in both eyes, black shadow in front of her eyes with headache for 2 weeks". She denied any history of previous ocular diseases, systemic medical history such as hypertension and diabetes, and denial of family genetic history. Denial of smoking history. She had a history of ulcerative colitis for 20 years. Ocular examination: the best corrected visual acuity (BCVA) in both eyes was 20/40 and 20/20; And there was no abnormality in the anterior segment of both eyes, no obvious clouding of the vitreous body; Funduscopic examination: the boundary of the optic disc in both eyes was clear, reddish color; Respectively, limited yellowish-white foci were seen in the superior temporal portion of the retina of both eyes and in the inferior portion of the left eye, which was shown in Figure 1A, 1B;
Ultrasound of both eyes: substantial space-occupying lesions were seen in the posterior pole of both eyes, which was shown in Figure 2A, 2B;
Bilateral optical coherence tomography (OCT) as showd in Figure 3: plasma retinal detachment in the posterior polar serous retinal of both eyes with choroidal bulge;
Fluorescein fundus angiography (FFA) as showd in Figure 4: Mottled strong fluorescence with leakage in the retina superior temporal of the right eye and the retina superior temporal and inferior temporal of the left eye, and ellipsoidal neuroepithelial detachment in the macular area of both eyes.
Initial diagnosis: posterior scleritis in both eyes? Choroid space-occupying lesions? Oral methylprednisolone is given temporarily.
After 5 days of medication, the patient's headache symptoms were significantly relieved, and the symptoms of blurred vision were improved, while further examinations such as head CT, blood routine, chest X-ray and other tests were performed. The patient's head CT did not show any obvious abnormality, the blood leukocytes were high, and the chest radiograph suggested that the right lung was inflamed. The rest of the examination did not show any obvious abnormality. The respiratory department consider "pulmonary infection" and treat it symptomatically with anti-inflammatory. On October 17th, the patient's vision did not improve significantly, and the respiratory department completed the chest CT: multiple lesions in the right lung, multiple swollen lymph nodes in the mediastinum, the right lung hilum and right diaphragmatic angle, uneven thickening of the right pleura, and a small amount of fluid in the right pleural cavity. On October 31, combined with the patient's previous medical history of ulcerative colitis, it was recommended that multiple departments such as respiratory, gastroenterology, rheumatology and immunology have a comprehensive examination. Gastroenterology, rheumatology and immunology examinations to rule out immune diseases. Chest CT and contrast-enhanced scan were performed again in the respiratory department: neoplastic lesions with carcinomatous lymphangitis were considered, bilateral adrenal metastases, and left branch of the portal vein was thrombosis. She was admitted to the respiratory department for inpatient treatment, and finally bronchoscopic biopsy confirmed the diagnosis of lung adenocarcinoma. At the same time, CT and enhancement scan of the upper abdomen were performed, suggesting: 1. Bilateral adrenal metastases should be considered; 2. Local thrombosis or cancer thrombosis in the left and right branches of the portal vein; 3. Hepatomegaly, uneven density and enhancement of liver parenchyma, considering the possibility of liver cirrhosis related to portal vein blood supply. Whole body emission computed tomography considered: benign changes in multiple anterior ribs on both sides; Abnormal bone metabolism in the skull, 2nd and 4th lumbar vertebrae, and right shoulder joints should be considered for bone metastases. The patient's final diagnosis: 1. Right lung adenocarcinoma combined with bilateral adrenal gland, both eyes choroidal and systemic bone metastasis; 2. Choroidal metastasis in both eyes. The patient was eventually receiving antitumor therapy in the respiratory department.