Background Cancer-associated retinopathy (CAR) is associated with various malignancies, including small cell lung cancer (SCLC). It is difficult to recognize, but prompt diagnosis is crucial for the patient, as retinopathy may be a herald sign that precedes systemic manifestations by months, thus allowing early treatment of the underlying malignancy. Case presentation We present a rare case of CAR with chorioretinitis and optic neuritis in a patient with occult SCLC. The patient presented with rapidly progressive peripheral field loss and photopsias with “prism-like” visual disturbances. Her symptoms stabilized with intravenous methylprednisolone, and her cancer was treated with carboplatin, etoposide and radiotherapy. Conclusions This is the first reported case of SCLC-associated CAR to present with chorioretinitis. CAR can be a herald feature of SCLC, and early recognition of the disease should prompt a systemic evaluation for an occult malignancy, which may be critical for patient survival. Further understanding of CAR pathogenesis may offer potential avenues for treatment.

BackgroundEye infection is one of the many potential sites of infection in persons who inject drugs (PWID). The purpose of this study was to determine the prevalence of chorioretinal (CR) lesions, identify causative organisms, and correlate symptoms with ophthalmic involvement in PWID hospitalized with bloodstream infection (BSI) and/or related metastatic foci of infection (MFI).MethodsActively using PWID 18 years or older admitted to Wake Forest Baptist Med Ctr with documented BSI or MFI related to injection drug use (IDU) were prospectively enrolled after providing informed consent. All patients, whether or not they had eye symptoms, received a dilated retinal examination as soon as feasible after admission. Ocular symptoms, visual acuity, and ocular examination findings were recorded and fundus photos were obtained as indicated. Patients could be re-enrolled if re-admitted with a different infection.ResultsFifty-three PWID with 55 episodes of disseminated infection related to IDU underwent ophthalmic exams at a median of 7 days post-admission. Mean age was 33.4 years and 51% were female. Twenty (38%) patients had HCV viremia but none had active HIV infection. Heroin was the injection drug of choice in 55% of patients. Of the 55 episodes of systemic infection, 33 were classified as infective endocarditis (IE), 6 were BSI only, 10 were BSI with MFI, and 5 were MFI without active BSI. Nine (17%) patients had CR involvement on examination but only 33% (3/9) were symptomatic. Of those with ocular involvement, 1 had fungal endophthalmitis due to Candida albicans. Single or multifocal subretinal infiltrates were found in 5/9 patients (MSSA 2, MRSA 2, H. parainfluenzae 1), 2/9 had cotton wool spots (S. mitis 1, MRSA 1), and 7/9 had intraretinal or white-centered hemorrhages (MSSA 3, MRSA 2, S. mitis 1, H. parainfluenzae 1). Of the 9 patients with CR lesions, 7 had IE. Interestingly, 3.8% (3/53) had old multifocal CR scars, possibly related to prior disseminated infection.ConclusionPWID admitted with BSI or MFI may have ophthalmic involvement even in the absence of ocular symptoms, especially in the setting of IE. Further study is needed to characterize the epidemiology of these infections, to identify risk factors for ocular involvement, and to optimize diagnosis and management.Disclosures All authors: No reported disclosures.