Single Isolated Cotton-Wool Spots

Abstract

The presence of isolated cotton-wool spots in normal fundi may indicate serious systemic disease. In this presentation 4 patients were examined for blurred vision or scotomas with sudden onset. Two of them were pregnant. Funduscopic examination revealed soft-appearing white spots in the temporal arcades in 3 patients and in the papillomacular bundle in 1 patient. Due to the lack of other fundus lesions 3 of the patients were initially treated for toxoplasmosis. The patients were seronegative for typical viral (HIV), antinuclear antibodies, bacterial infections, or toxoplasmosis. Blood pressures, glycosylated hemoglobin and blood counts were in the normal range. At the follow-up examinations subjective symptoms had improved and the spots disappeared or were smaller and showed more distinct borders, and no new lesions were detected. These cases suggest that isolated cotton-wool spots may occur without serious systemic disease in otherwise healthy subjects and the spots may be misinterpreted as acute inflammatory retinochoroidal lesions.

An atypical presentation of Kikuchi-Fujimoto disease mimicking systemic lupus erythematosus: case report and literature review

“…They represent acute, focal, inner retinal ischemia and may occur in any disease that compromises arteriolar circulation to the inner retinal layers which includes SLE and systemic vasculitides where ischemia is caused by thrombogenic effects from antigen-antibody complexes [20]. However, similar to our patient, isolated, self-limited cotton wool spots in patients with no identifiable systemic disease have also been reported [21].…”