Purpose

Sclerochoroidal calcification (SCC) is an unusual and poorly recognized ocular condition which is usually presented as an incidental finding in asymptomatic individuals. An exhaustive diagnosis is required as it may be commonly misdiagnosed such as choroidal osteoma, choroidal metastasis, amelanotic choroidal nevus, or lymphoma. It is commonly idiopathic but ophthalmologists should be aware of the possible association with severe ocular trauma and chronic intraocular inflammation, or with abnormal calcium-phosphorus metabolism

Methods

We report the case of a 78-year-old woman with a medical history of breast cancer treated with quadrantectomy followed by adjuvant chemotherapy and radiotherapy, and Letrozole (aromatase inhibitors) for 3 years, which was discontinued when a hypercalcaemia and primary hyperparathyroidism (PHPT) related to a parathyroid adenoma. Oncological follow-up was negative until during a routine examination prior to a right eye cataract intervention, dilated fundus examination revealed bilateral multiple asymptomatic yellow placoid lesions

Results

The patient's best-corrected visual acuity (BCVA) was 20/20 in the right and left eye. Tomography–computed tomography (OCT-scan), Magnetic resonance imaging (MRI) and Positron emission tomography–computed tomography (18-FDG PET-TC) revealed diffuse calcification in the choroid plexus bilaterally as well as calcification in the posterior aspect of both globes with no changes in metabolism at these levels. A SCC secondary to hypercalcaemia and PHPT related to a parathyroid adenoma was diagnosed. She was referred to endocrinology specialist to rule out systemic conditions. As the patient stills refusing surgery, she was treated with Cinacalcet (a calcimimetic) with regular follow-up in the endocrinology clinic. Dilated fundus examination and OCT are performed periodically. For the time being, the patient remains asymptomatic and the lesion stays stable.

Conclusions

All patients with SCC should be tested for underlying systemic disorders involving abnormal calcium-phosphorus metabolism to avoid complication or unwarranted intervention resulting from the misdiagnosed as a malignant tumor. Periodic ophthalmology studies are required as well to rule out possible complications.