A case of multiple evanescent white dot syndrome as epiphenomenon of cytomegalovirus infection.

Purpose: To report a case of possible epiphenomenon of multiple evanescent white dot syndrome (epi-MEWDS) in setting of cytomegalovirus (CMV) infection. Observations: A healthy 36-year-old male presented with bilateral painless floaters for 3 days and concurrent symptoms of fatigue, myalgia, and diarrhea. Clinical examination revealed bilateral multifocal retinal white dots and panuveitis that were more prominent in the right eye, with retinal imaging findings consistent with MEWDS. Panuveitis due to ocular or systemic infection was initially suspected. Anterior chamber paracentesis for viral polymerase chain reaction analysis was negative. However, systemic lab test revealed positive CMV IgM and IgG antibodies. Treatment was deferred given mild symptoms and immunocompetent status of the patient, and the retinal pathologies and panuveitis self-resolved in 2 months. Conclusions and importance: Diagnosis of epi-MEWDS requires careful clinical examination and supportive imaging findings. In our case, the combination of systemic symptoms, CMV serology, compatible multimodal imaging, and timeline of spontaneous resolution supports the CMV as the triggering event for a para-infectious MEWDS-like immune response, consistent with epi-MEWDS. This report adds to the currently limited literature on epi-MEWDS as a possible self-limiting immunologic response to an underlying infectious process.