Metastatic Cutaneous Amelanotic Melanoma to the Vitreous Masquerading as a Fungal Endophthalmitis

This report presents a case of amelanotic metastatic cutaneous melanoma to the vitreous masquerading as a fungal endophthalmitis. A 74-year-old immunocompromised man with a history of Stage 4 metastatic cutaneous melanoma presented with 1+ vitreous cell and a fluffy white peripheral infiltrate in the left eye. Following subsequent vitrectomy for a vitreous hemorrhage, this patient developed preretinal macular deposits that continued to increase in size while undergoing treatment for a presumed fungal endophthalmitis. The patient went on to develop a total retinal detachment with a diffuse hemorrhagic retinopathy. Cytopathologic analysis revealed necrotic melanoma cells from the preretinal surface and within the vitreous cavity. This case highlights the importance of including vitreous metastasis in the differential of vitritis in the setting of cutaneous melanoma. Optical coherence tomography can be used to monitor the progression of preretinal deposits, with an increase in size of the deposits prompting reevaluation of treatment options.