 Alright guys, so I'm going to present a very interesting case which is still somewhat of a mysterious case as far as what's going on with this patient. So this is patient OM, he's a four-year-old male, he was initially seen by an outside ophthalmologist in August of 2015, complaining of a red right eye for the past two months. The parents did not observe any changes in his visual behavior at that time. The review of systems was significant for a brief episode of diarrhea in December of 2014, but it was self-limited, it was all spontaneously, and then the only other pertinent past medical history was that his family history was significant for a cousin with parisplanitis. So upon presentation at the outside ophthalmologist's office, his visual acuity was 20-30 in the right eye, 20-20 in the left eye, pupils, pressure, as well as his extracurricular movements and visual fields were all within normal limits. On examination, he had about one-plus injection in the right eye, two-plus cell and one-plus flare in the anterior chamber of his right eye, and he had this very particular pigmented mass in the inferior angle of his right eye, which I'll show you soon. He also had some posterior synique, as well as pigment on the anterior capsule and trace nuclear sclerotic cataracts in the right eye only. So here you can see in the image on the left, in the inferior angle down there, you can see this large pigmented mass right there, and the image on the right, you can see some posterior synique. Here's an ocular ultrasound of the pigmented mass in the inferior angle here. And on fundus examination, he had about two-plus cell and haze in the right eye, and he also had these multifocal white caroidal lesions throughout the macula, as well as in the mid periphery. He also had some mild disc edema as well, and this was also appreciated in the left eye. On fluorescein angiogram, we see some late disc leakage, as well as staining of those multifocal caroidal lesions in the right eye, as well as in the left eye here. On ultrasound, you can see some fluid in the super caroidal space in both eyes. And on OCT, you can appreciate some subretinal fluid in the right eye and none in the left eye. So the outside ophthalmologist initiated a brief workup, a brief serologic workup, showing a negative line panel, TOXO, RPR, and FTA-ABS. Now, this outside ophthalmologist was also a trained ocular oncologist. So what they did was they performed aspiration biopsy of this iris mass, and they came back GIMSA as well as AFB-stained negative. The imu histochemistry did not show any markers suggested for malignancy either. It was deemed to be a benign inflammatory process. So at this point, they placed him on Predforte and sent him to Dr. Vitaly for further evaluation. Upon arrival, his vision in that eye was 2050 in the right, 2025 in the left. Once again, pressure, pupils, confrontation of visual fields and movements were all within normal limits. Anteer chambers still had two plus cell, one plus flare. And he still had this pigmented mass in the inferior angle of his right eye. Lens was pretty much the same as his previous exam. On fundus examination, these multifocal caroidal lesions actually seemed a little bit flatter and a little bit smaller as well, compared to the images that they sent over to Dr. Vitaly. And here you can see it as well in the left eye. The OCT showed that the sub-retinal fluid actually resolved over time. So at this point, Dr. Vitaly wanted to initiate more of an extensive workup to rule out any infectious or inflammatory etiologies. Most notably, it was negative for Bartonala-Hensley-Quintana titers, as well as his human herpivirus VI IgM, as well as Epstein-Barvirus IgM titers as well. But it was elevated for his HHV6, as well as the EBV IgG levels. He had a slightly decreased white blood cell count, but nothing to run home about, essentially. So at this point, he was diagnosed with panuveitis, with multifocal caroidal lesions. The right eye affected more than the left eye. The differential at this point included blouse syndrome, which is a multi-systemic granulomatous disorder, which mimics juvenile sarcoid, which is why juvenile sarcoid is also differential. EBV-associated retinocorrhiditis, and possibly a common variable immunodeficiency disease, which can be associated sometimes with a granulomatous uveitis as well. He was placed on a prednisone taper, as well as oral valtrex, and followed up closely. At his subsequent visits, he had a quiet anterior chamber. The iris mass was completely resolved on its own, well, with the treatment for what we think. And then there was flattening of the caroidal lesions in both eyes as well. And so at this point, we thought that it was less likely due to a viral etiology. So they tapered the valtrex, the suppressive dose, and continued the prednisone taper. And here are images of the lesions. They seem a little bit flatter. They're not as elevated as when he initially presented. Of note, he was seen by pediatric ophthalmology back in October. What they noticed was a new erythema in his popular rash on his face as well as on his arms. However, when dermatology saw him, they just thought it was due to keratosis polaris, which is a benign follicular skin condition. They didn't think much of it. When he next saw us in November, he had a recurrence of his anterior chamber cell. The ridae affected more than his left. And at this point, he was actually off his prednisone as well as his predforte for about a month. So Dr. Vitaly decided to start him on methotrexate at this point because of the recurrent nature of this condition, as well as this result in ocular structural damage that was associated with this condition as well. And on his subsequent visits on methotrexate as well as the steroid bridge, he had a quiet anterior chamber. There are no changes on his fundus examination and his skin rash actually also resolved. So we continue the methotrexate as well as the steroid taper. And he's planning on getting blouse syndrome genetic testing in the near future. So really the diagnosis is up in the air at this point. However, some discussion questions are, is the resolution of the ocular signs and ocular findings as well as the skin rash after starting methotrexate suggestive of this being juvenile sarcoid or some other immune mediated process can also think about blouse syndrome, which very much mimics juvenile sarcoid, which is predominantly characterized by arthritis as well as skin manifestations in the ocular findings. And lastly, just for a discussion point or food for thought, do you think early management in the early workup was an aspiration biopsy of this iris mass really necessary and is it safe? This is something to think about as well. I'd like to thank Dr. Vitaly for giving me this opportunity to present this case. And we'll take any questions.