A 33-year-old woman with a medical history of deceased donor renal transplant receiving immunosuppressive therapy with prednisone and sirolimus complained of progressive visual loss during hospitalization for an episode of recurrent transplant rejection a few months following transplantation. Dilated fundus examination revealed bilateral retinal pigment epithelium mottling, focal pigment epithelial detachments within the macula, and inferior serous retinal detachments. Fluorescein angiogram revealed multifocal expansile dots of leakage, consistent with multifocal central serous chorioretinopathy. Spectral-domain optical coherence tomography showed neurosensory detachments with subretinal deposits and well-defined hyperreflective membrane underlying elongated photoreceptor outer segments. This subretinal membrane, seen in the detached portion of retina, has not been described before in organ transplant patients with central serous chorioretinopathy. This finding may have relevance to the fibrinous deposits and septations described in patients with Vogt-Koyanagi-Harada syndrome.
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