Miliary retinitis in coccidioidomycosis.

We studied the pathologic features of a rare case of coccidioidomycosis retinitis in a 12-year-old girl. At autopsy there were multiple small lesions throughout the vital organs. Ocular lesions were restricted to the posterior part of the fundus. Step-level serial sectioning including the optic axes of both eyes showed 29 discrete retinal and 22 choroidal granulomas. Topographic analysis demonstrated random distribution of lesions throughout the fundus. Retinal granulomas were centered within layers served by the retinal circulation. Choroidal lesions most often involved the middle vascular layer and in only two areas focally disrupted Bruch's membrane. The pigment epithelium was intact. Retinal granulomas were not topographically associated with choroidal lesions.