Bilateral diffuse uveal melanocytic proliferation (BDUMP) is a rare paraneoplastic syndrome. Diagnosis can be difficult and treatment guidelines are ill-defined. A 73-year-old man with poorly differentiated high grade urothelial carcinoma of the ureter metastatic to the liver, lungs, lymph nodes, and pelvis treated with chemotherapy and immunotherapy reported gradual vision loss. Optical coherence tomography (OCT) demonstrated intraretinal and subretinal fluid with hyperreflective subretinal deposits and focal, deeply pigmented choroidal lesions. Irregular hyperpigmentation of the retinal pigment epithelium (RPE) with a "leopard spot" pattern on fundus autofluorescence (FAF) supported the diagnosis of BDUMP. Multiple plasmapheresis sessions did not result in sustained clinical improvement. .
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