Retinal vasoproliferative granulomatous lesion associated with hand pyoderma caused by streptococcus pyogenes

Purpose: To report a retinal vasoproliferative granulomatous lesion in association with pyoderma. Design: Single case report. Methods: A 32-year-old woman had blurred central vision in the right eye, concurrent with pyoderma of the fingers of both hands, 2 days later followed by fever. Results: The patient had a granulomatous lesion in the upper retina, which caused leakage, leading to subretinal and intraretinal accumulation of hard exudates in the posterior pole, together with periphlebitis extending over the wider area of the retina. The culture of the pyodermic lesion detected Streptococcus pyogenes. With the 2-month course of amoxicillin-clavulanate, combined with prednisolone tapered from 30 mg daily, the visual acuity (decimal fraction) in the right eye returned from 0.01 (logMAR=2) to 0.9 (logMAR=0.1). However, after the discontinuation of the antibiotics and prednisolone, the retinal lesion became more vasoproliferative and caused leakage to reduce the vision again. The leakage was remedied by laser photocoagulation to the retinal lesion. Conclusions: The retinal granulomatous lesion was caused by streptococcal infection in pyoderma and later became more vasoproliferative with macroaneurysms and microaneurysms even after the initial subsidence of the lesion with antibiotics treatment.