A 23-year-old male Asian Indian patient presented with bilateral progressive diminution of vision of five days duration associated with photopsia and global headache of mild severity. There was no history of redness of eyes, photophobia, preceding flu-like illness, skin rash, arthritis, backache, dysuria and contact with tuberculosis patients. The best-corrected visual acuity (BCVA) of right eye (RE) was 6/12 and left eye (LE) was 6/24. The pupillary reactions of both eyes were normal. Fine

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... tic precipitates with +2 anterior chamber cells and flare were seen. The optic disc in both eyes were hyperemic and edematous with blurring of the margins. The retinal vessels were normal. Multiple discrete whitish-yellow choroidal lesions were seen, extending from posterior pole to equator seen symmetrically in both eyes (BE). Minimal pre-retinal vitritis was seen. Spectral domain optical coherence tomography (OCT) of the lesions showed loss of ellipsoid zone, retinal pigment epithelium (RPE) hyper-reflectivity and homogeneity of the underlying choroid. The fovea of both eyes was involved with minimal ellipsoid zone disruptions. Fundus fluorescein angiography (FFA) showed early hypofluorescence and late hyperfluorescence at site of lesions with optic disc leakage in late phases. On short-wave fundus autofluorescence (FAF), the lesions appeared hyperautofluorescent centrally with hypoautofluorescent edges. Based on the young age of patient, short disease duration of five days, associated photopsia and headache, bilateral presentation with mild visual loss, anterior uveitis,creamy choroidal lesions and disc leakage, a differential diagnosis of white dot syndrome versus multifocal choroiditis was further investigated. The haemogram and C-reactive protein levelswere normal. QuantiFERON-Tuberculosis (TB) Gold test levels were negative and contrast-enhanced computed tomography scan of chest was normal. The patient was negative for Human immunodeficiency virus (HIV), Syphilis, Lyme's, Leptospirosis, toxoplasma, toxocara, herpes simplex virus, varicella zoster virus, Hepatitis B and Hepatitis C serology. Pulmonary function tests and serum angiotensin converting enzyme (ACE) levels were normal. Rheumatoid factor, anti-nuclear antibody (ANA) and cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA) levels were normal. Two days after the initial presentation, the number and size of lesions had increased and BCVA worsened by one line in both eyes. At this stage,the patient was started on intravenous methylprednisolone (IVMP) 1 gram per day for three consecutive days followed by oral prednisolone 1.5 mg/kg/ day. Seven days after starting treatment the BCVA improved to 6/9 in RE and 6/12 in LE. The anterior chamber reaction and vitritis got resolved in BE. Disc edema and hyperemia had reduced in BE. Choroidal lesions in BE became more well Clinical Challenge Figure 1: Right eye color fundus picture at onset (a) Optic disc hyperemia and edema with multiple choroidal lesions (b) the lesions are moderately well defined and cream colored (c) supero-temporal view showing extension till equator (d) infero-temporal view (e) nasal view. Figure 2: Left eye color fundus picture at onset shows symmetrical involvement (a) Optic disc is hyperemic and edematous with multiple choroidal lesions (b) the lesions are moderately well defined and cream colored (c) superotemporal view showing extension till equator (d) infero-temporal view (e) nasal view.