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Diffuse unilateral subacute neuroretinitis (DUSN) is a progressive retinal disorder related to subretinal migration of a nematode worm, usually occurring in healthy individuals.1–3 It was reported first in North America and subsequently in South America and Asia.4,5 Different species of nematode have been identified,6 with a larger worm identified as a common parasite of raccoons (Baylisascaris procyonis), and a smaller worm causative of DUSN not yet characterised taxonomically. The early phase of the disease may show round yellowish outer retinal lesions with retinal pigment epithelium (RPE) changes and possible mild vitritis or papilloedema.1–3 Late stages show multiple chorioretinal atrophic lesions, vessel narrowing, and disc pallor. Differential diagnoses include multifocal choroiditis and other “white dot syndromes.” Careful and repeated examination may be necessary to detect the worm. Treatment relies on identification of the worm during funduscopy and direct thermal coagulation. Recently, a series of patients have shown benefit when treated orally with the anthelmintic agent, albendazole.7
We report DUSN in a young boy in whom progressive electrophysiological deterioration occurred over a 4 year period before the worm was detected.
A healthy 9 year old boy, born in the …