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Magdum R, Agrawal T, Bhavsar D, Giri N, Radhakrishnan O. Rare Case of Tubercular Serpiginous-Like Choroiditis. Cureus 2024; 16:e57093. [PMID: 38681413 PMCID: PMC11055604 DOI: 10.7759/cureus.57093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
Serpiginous choroiditis is a rare cause of posterior uveitis, included in the spectrum of white dot syndromes. It occurs as a result of an autoimmune process but could be associated with infections such as tuberculosis (TB) (serpiginous-like choroiditis). Tubercular serpiginous-like choroiditis is more commonly reported in Southeast Asian countries than in Western countries. We report a case of an Indian male in his late 30s with bilateral grey-yellowish subretinal infiltrates at the level of choroid with active scalloped edges having a positive TB-QuantiFERON Gold test (Cellestis Limited, Carnegie, Australia), who responded well to the treatment of intravenous methylprednisolone and systemic steroids (given initially to control the acute inflammation) while on anti-tubercular (anti-TB) therapy. The lesions finally completely healed on the anti-TB therapy.
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Affiliation(s)
- Renu Magdum
- Ophthalmology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Tushar Agrawal
- Ophthalmology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Deepaswi Bhavsar
- Ophthalmology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Nilesh Giri
- Ophthalmology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Ozukhil Radhakrishnan
- Ophthalmology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
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Herbort CP, Arapi I, Papasavvas I, Mantovani A, Jeannin B. Acute Zonal Occult Outer Retinopathy (AZOOR) Results from a Clinicopathological Mechanism Different from Choriocapillaritis Diseases: A Multimodal Imaging Analysis. Diagnostics (Basel) 2021; 11:diagnostics11071184. [PMID: 34209956 PMCID: PMC8303680 DOI: 10.3390/diagnostics11071184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 11/16/2022] Open
Abstract
Background and aim: AZOOR is a rare disease characterized by loss of zones of outer retinal function, first described by J Donald Gass in 1993. Symptoms include acute onset photopsias and subjective visual field losses. The syndrome is characterized by a normal fundus appearance, scotomas and electroretinographic changes pointing towards outer retinal dysfunction. Evolution, response to immunosuppressive treatment and outcome are difficult to predict. The aim of this small case series was to identify the morphological changes and sequence of events in AZOOR thanks to multimodal imaging. Methods: Charts of AZOOR patients seen in the Centre for Ophthalmic Specialized care (COS, Lausanne, Switzerland) were analyzed by multimodal imaging including fundus photography, fluorescein angiography (FA), indocyanine green angiography (ICGA), blue light fundus autofluorescence (BL-FAF) and spectral domain optical coherence tomography (SD-OCT) in addition to a complete ophthalmological examination including visual field testing and microperimetry, as well as OCT angiography (OCT-A) and ganglion-cell complex analysis when available. Cases and Results: Three AZOOR patients with a mean follow-up of 47 ± 25.5 months were included following the clinical definitions laid down by J Donald Gass. The primary damage was identified at the level of the photoreceptor outer segments with an intact choriocapillaris and retinal pigment epithelium (RPE) layer, these structures being only secondarily involved with progression of the disease. Conclusion: Although AZOOR has often been included within white dot syndromes, some of which are now known to be choriocapillaris diseases (choriocapillaritis entities), our findings clearly commend to differentiate AZOOR from entities such as MEWDS (Multiple evanescent white dot syndrome), APMPPE (Acute Posterior Multifocal Placoid Pigment Epitheliopathy), MFC (Multifocal Choroiditis) and others, as the damage to photoreceptors is primary in AZOOR (a retinopathy) and secondary in choriocapillaritis (a choriocapillaropathy).
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Affiliation(s)
- Carl P. Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialised Care (COS), Clinic Montchoisi Teaching Centre, 1006 Lausanne, Switzerland; (I.P.); (B.J.)
- Correspondence:
| | - Ilir Arapi
- Department of Ophthalmology, University Hospital Centre “Mother Teresa”, 1000 Tirana, Albania;
| | - Ioannis Papasavvas
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialised Care (COS), Clinic Montchoisi Teaching Centre, 1006 Lausanne, Switzerland; (I.P.); (B.J.)
| | | | - Bruno Jeannin
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialised Care (COS), Clinic Montchoisi Teaching Centre, 1006 Lausanne, Switzerland; (I.P.); (B.J.)
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Wykrota AA, Löw U, Fries FN, Seitz B, Abdin AD. [Unilateral Irregularities in the Macular Pigment Epithelium in a 38-Year-Old Patient - "Acute Retinal Pigment Epitheliitis"]. Klin Monbl Augenheilkd 2020; 239:304-307. [PMID: 33036057 DOI: 10.1055/a-1241-4521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Agata Anna Wykrota
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Ursula Löw
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes, Homburg/Saar
| | | | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Alaa Din Abdin
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes, Homburg/Saar
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Dhafiri Y, Al Rubaie K, Kirat O, May WN, Nguyen QD, Kozak I. Multifocal Choroiditis with Retinal Vasculitis, Optic Neuropathy, and Keratoconus in a Young Saudi Male. Middle East Afr J Ophthalmol 2017; 24:109-112. [PMID: 28936058 PMCID: PMC5598301 DOI: 10.4103/meajo.meajo_331_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The purpose of this study is to describe an association of unilateral multifocal choroiditis (MFC), retinal vasculitis, optic neuropathy, and bilateral keratoconus in a young Saudi male. A 27-year-old male patient with stable bilateral keratoconus presented with a painless vision loss in his left eye. Ophthalmic examinations revealed multiple foci of idiopathic chorioretinitis, retinal vasculitis, and mild optic disc leakage on fluorescein angiography, all of which resolved on systemic therapy with mycophenolate mofetil and prednisone after 3 months. Systemic medication was stopped after 8 months. One year after presentation, patient's visual acuity has improved and remained stable. Systemic immunomodulatory therapy can be effective in managing and leading to resolution of MFC, retinal vasculitis, and optic disc leak in young patients.
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Affiliation(s)
- Yousef Dhafiri
- King Khaled Eye Specialist Hospital, Al-Arouba, Riyadh 11462, Kingdom of Saudi Arabia
| | - Khalid Al Rubaie
- King Khaled Eye Specialist Hospital, Al-Arouba, Riyadh 11462, Kingdom of Saudi Arabia
| | - Omar Kirat
- King Khaled Eye Specialist Hospital, Al-Arouba, Riyadh 11462, Kingdom of Saudi Arabia
| | - William N May
- King Khaled Eye Specialist Hospital, Al-Arouba, Riyadh 11462, Kingdom of Saudi Arabia.,Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Quan D Nguyen
- University of Nebraska Medical Center, Truhlsen Eye Institute, Omaha, NE, USA
| | - Igor Kozak
- King Khaled Eye Specialist Hospital, Al-Arouba, Riyadh 11462, Kingdom of Saudi Arabia
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5
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Zollfrank C, Gamulescu MA, Prahs P, Helbig H. [Fundus autofluorescence in multiple evanescent white dot syndrome]. Ophthalmologe 2012; 110:54-6. [PMID: 22547127 DOI: 10.1007/s00347-012-2585-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Multiple evanescent white dot syndrome (MEWDS), an entity belonging to the group of white dot syndromes, is characterized by pale spots at the posterior pole as a sign of inflammatory changes in the choroid and pigment epithelium. These spots are sometimes difficult to define by fundoscopy. Besides angiography fundus autofluorescence has been shown to be an excellent, noninvasive method to demonstrate these subretinal spots in MEWDS.
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Affiliation(s)
- C Zollfrank
- Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg.
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Neutzner RV, Jäger M, Friedburg C, Deeg CA, Lorenz B. [Blind spot enlargement syndrome in acute zonal occult outer retinopathy with detection of autoantibodies against the retinal antigens CRALBP and S-Ag]. Ophthalmologe 2012; 108:1045-9. [PMID: 21904838 DOI: 10.1007/s00347-011-2406-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Acute zonal occult outer retinopathy (AZOOR) is a rare disease and is part of the white dot syndrome occurring bilaterally and often asymmetrically in young healthy myopic women. Characteristic findings are distinct focal lesions of the outer segments (OS) of the photoreceptor (PR) layer and abnormalities in fundus autofluorescence (FAF) within the lesions. Currently there is a lack of defined disease criteria, such as specific laboratory findings. Also no effective therapy is known which makes it difficult to diagnose, differentiate and treat AZOOR. Supplementation of antioxidants may become part of therapeutic options in AZOOR. A 19-year-old myopic woman presented with unilaterally reduced visual acuity. Due to the clinical features and with the help of FAF, spectral domain optical coherence tomography (SD-OCT) and perimetry the diagnosis of blind spot enlargement syndrome in AZOOR was made. Identification of autoantibodies specific for two retinal antigens (CRALBP and S-Ag) supports the concept of an autoimmunological origin of the disease. Systemic steroids were given but stopped almost 6 weeks later as no improvement was seen. In follow-up controls over 12 months the clinical picture remained unchanged without any further therapy.
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Affiliation(s)
- R V Neutzner
- Klinik und Poliklinik für Augenheilkunde, Justus-Liebig-Universität Gießen, UKGM GmbH, Standort Gießen, Gießen, Deutschland.
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Weiss S, Winter R, Meyer MW. [Punctate inner choroidopathy - Improvement in vision after anti-VEGF and photodynamic therapy. An 18-month follow-up control]. Ophthalmologe 2011; 109:149-54. [PMID: 22130726 DOI: 10.1007/s00347-011-2449-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Punctate inner choroidopathy (PIC) is a rare disease which seems to have an inflammatory origin. Treatment is symptom-oriented and the development of choroidal neovascularization (CNV). If CNV is present the trend is towards the use of anti-VEGF (vascular endothelial growth factor) therapy. Oral therapy with steroids should be initially attempted.
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Affiliation(s)
- S Weiss
- Augenklinik der Medizinischen Hochschule Hannover, Carl-Neuberg Str. 1, 30625, Hannover, Deutschland.
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[Juvenile pontine infarction. Complication of acute posterior multifocal placoid pigment epitheliopathy]. DER NERVENARZT 2011; 82:496, 498-9. [PMID: 21221525 DOI: 10.1007/s00115-010-3118-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Maier M, Feucht N, Lanzl I, Kook P, Lohmann C. Retinochoroidopathie nach intravitrealer Anti-VEGF-Behandlung. Ophthalmologe 2008; 106:729-34. [DOI: 10.1007/s00347-008-1839-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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