1
|
Krzemińska J, Kurek A, Żebrowska A, Waszczykowska A. HLA-A29 Negative Birdshot-like Chorioretinopathy Associated with Vitiligo-Case Report. J Clin Med 2024; 13:4808. [PMID: 39200949 PMCID: PMC11355317 DOI: 10.3390/jcm13164808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 07/29/2024] [Accepted: 08/12/2024] [Indexed: 09/02/2024] Open
Abstract
A 54-year-old, one-eyed Caucasian male was admitted to the Ophthalmology Clinic due to a gradual deterioration of vision in the right eye for approximately two weeks. The patient denied any trauma or viral infection during this time. On the day of admission, the patient's best corrected visual acuity (BCVA) in the right eye was 0.5 on the Snellen scale. The patient's left eye had been atrophied for several years, with no light perception and no visibility of the fundus due to previous trauma and multiple surgeries. Ophthalmologic examination of the anterior segment and vitreous body of both eyes showed no signs of inflammation. Fundus examination of the right eye revealed scattered inflammatory foci, creamy-yellow and round, visible in all sectors. Laboratory tests, imaging studies, optical coherence tomography (OCT) angiographies, OCTs of the macula and optic nerve head, fluorescein angiographies (FAs), electroretinograms (ERGs), and visual field tests were performed. These examinations led to a diagnosis of a disease resembling birdshot-like chorioretinopathy. Immunogenetic testing of the patient did not reveal the presence of human leukocyte antigen (HLA)-A29. Dermatological and immunological consultations were conducted, and a differential diagnosis was made. Due to the reduced visual acuity (VA) observed and the inability to assess the left eye, a high-dose corticosteroid therapy was initiated, which was gradually tapered, along with the application of an immunosuppressive drug. The course of the disease was typical for birdshot chorioretinopathy, with chronic periods of remissions and exacerbations. The patient's clinical improvement was only achieved after co-administration of general corticosteroids at a dose of 0.5-1 mg/kg/day, mycofenolate mofetil, and periocular (sub-Tenon's) triamcinolone.
Collapse
Affiliation(s)
- Julia Krzemińska
- Department of Ophthalmology, Medical University of Lodz, 90-153 Lodz, Poland; (J.K.); (A.K.)
| | - Anna Kurek
- Department of Ophthalmology, Medical University of Lodz, 90-153 Lodz, Poland; (J.K.); (A.K.)
| | - Agnieszka Żebrowska
- Department of Dermatology and Venereology, Medical University of Lodz, 90-647 Lodz, Poland;
| | - Arleta Waszczykowska
- Department of Ophthalmology, Medical University of Lodz, 90-153 Lodz, Poland; (J.K.); (A.K.)
| |
Collapse
|
2
|
Olazaran L, Jiménez A, González de los Mártires P, Guerrero G, Gangoitia N, Salmeron I, Galarza A, Argüelles AS, Elso B, Reyzabal I, Compains E, Heras H, López S. White Dot Syndromes: Report of Three Cases. Case Rep Ophthalmol 2024; 15:202-211. [PMID: 38487796 PMCID: PMC10939511 DOI: 10.1159/000536336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/31/2023] [Indexed: 03/17/2024] Open
Abstract
Introduction The term white dot syndromes has been used to refer conditions that differ in their morphology and prognosis. We report three cases of different pathologies encompassed within the white dot syndromes. Case Presentations Case 1: A 26-year-old female presented with scotoma in her right eye. Fundus examination revealed multiple white dots that demonstrated early hyperfluorescence with late staining on FA. OCT showed discontinuities in inner segment-outer segment junction associated with columnar-shaped outer retinal hyperreflective bands. AF revealed multiple hyperautofluorescent dots around the posterior pole, compatible with multiple evanescent white dot syndrome. The symptoms improved without treatment. Case 2: A 16-year-old male presented with retinal lesions compatible with punctate inner choroidopathy in his right eye. OCT showed lesion in the outer retinal layer. FAF revealed parafoveal hypoautofluorescent dots with early hyperfluorescence and late staining on FFA. After oral corticotherapy, they progress to atrophic scars. Case 3: A 65-year-old male presented with scotoma and decreased vision in his right eye. OCT showed hyperreflectivity in the outer layer that progresses to a large atrophic plaque with foveal affectation. FAF demonstrated hyperautofluorescent placoid lesion occupying macular area, compatible with acute posterior multifocal placoid pigment epitheliopathy. Retinal lesions improved with systemic corticosteroids. Conclusion The FAF pattern helps know the distribution of the lesions. It represents a noninvasive method that has been shown to be useful in the diagnosis and monitoring of white dot syndromes.
Collapse
Affiliation(s)
- Leire Olazaran
- Department of Ophthalmology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Ana Jiménez
- Department of Ophthalmology, Hospital Universitario de Navarra, Pamplona, Spain
| | | | - Gonzalo Guerrero
- Department of Ophthalmology, Fundación Hospital Calahorra, Calahorra, Spain
| | - Nerea Gangoitia
- Department of Ophthalmology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Iñigo Salmeron
- Department of Ophthalmology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Ane Galarza
- Department of Ophthalmology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Ana Sofía Argüelles
- Department of Ophthalmology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Beatriz Elso
- Department of Ophthalmology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Irene Reyzabal
- Department of Ophthalmology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Esther Compains
- Department of Ophthalmology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Henar Heras
- Department of Ophthalmology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Santiago López
- Department of Ophthalmology, Hospital Universitario de Navarra, Pamplona, Spain
| |
Collapse
|
3
|
Barbosa RC, Gonçalves R, Vieira B. Atypical case of acute posterior multifocal placoid pigment epitheliopathy with intraretinal fluid. BMJ Case Rep 2023; 16:e255464. [PMID: 37798044 PMCID: PMC10565154 DOI: 10.1136/bcr-2023-255464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
Acute posterior multifocal placoid pigment epitheliopathy is a rare inflammatory chorioretinopathy, classified as a white dot syndrome, in which ischaemia of the choriocapillaris leads to atrophy of the external retinal layers, including the retinal pigment epithelium.A male patient in his 20s presented with sudden severe loss of vision in the left eye. Funduscopy revealed with yellow placoid lesions in the macula and near periphery. Spectral-domain optical coherence tomography and fluorescein angiography revealed the presence of central intraretinal fluid in the left eye and multiple areas of macular ischaemia bilaterally. Treatment with oral corticosteroids was initiated, and the anatomical changes, including the intraretinal fluid, improved steadily over the following weeks.Although rare, the presence of subretinal or intraretinal fluid should not decrease the suspicion of acute posterior multifocal placoid pigment epitheliopathy. Reabsorption of the fluid is usually accompanied by the improvement of the remaining anatomical changes and the visual function.
Collapse
Affiliation(s)
| | - Rita Gonçalves
- Ophthalmology Department, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Bruna Vieira
- Ophthalmology Department, Hospital Pedro Hispano, Matosinhos, Portugal
| |
Collapse
|
4
|
Testi I, Vermeirsch S, Pavesio C. Acute posterior multifocal placoid pigment epitheliopathy (APMPPE). J Ophthalmic Inflamm Infect 2021; 11:31. [PMID: 34524577 PMCID: PMC8443720 DOI: 10.1186/s12348-021-00263-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a rare inflammatory eye disease, affecting the inner choroid and the outer retina. Recent advances in multimodal imaging have been important in the understanding of the pathophysiology of the disease, allowing a better characterization of the morphology of this condition. Methods Narrative review. Results In this review, a comprehensive overview of clinical features, imaging findings, treatment management, and long-term outcomes of patients with APMPPE will be provided. Conclusions Although APMPPE was originally believed to be a self-limited condition with a good prognosis, the disease can be recurrent and result in significant loss of vision function. Fundus imaging plays an important role in the diagnosis and management of the disease, allowing to evaluate response to treatment and onset of complications.
Collapse
Affiliation(s)
- Ilaria Testi
- Department of Uveitis, Moorfields Eye Hospital, National Health Service Foundation Trust, 162 City Rd, Old Street, London, EC1V 2PD, UK
| | - Sandra Vermeirsch
- Department of Uveitis, Moorfields Eye Hospital, National Health Service Foundation Trust, 162 City Rd, Old Street, London, EC1V 2PD, UK
| | - Carlos Pavesio
- Department of Uveitis, Moorfields Eye Hospital, National Health Service Foundation Trust, 162 City Rd, Old Street, London, EC1V 2PD, UK.
| |
Collapse
|
5
|
Tummala GC, Chu Z, Weinstein JE, Wang RK, Pepple KL. Swept source OCTA reveals a link between choriocapillaris blood flow and vision loss in a case of tubercular serpiginous-like choroiditis. Am J Ophthalmol Case Rep 2021; 21:101018. [PMID: 33553805 PMCID: PMC7851177 DOI: 10.1016/j.ajoc.2021.101018] [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: 05/17/2020] [Revised: 10/20/2020] [Accepted: 01/11/2021] [Indexed: 11/25/2022] Open
Abstract
Optical coherence tomography angiography (OCTA) is a non-invasive technique that is useful in the diagnosis and management of patients with posterior uveitis. Here we report the use of swept source OCTA (SS-OCTA) in a patient with tuberculosis (TB) associated serpiginous like choroiditis (TB-SLC) that made a full visual recovery following treatment with ATT, local and systemic corticosteroids, and systemic immune modulation. By comparing en face images of choriocapillaris (CC) blood flow before and after treatment, we conclude that the patient's visual recovery was associated with resolution of extensive CC flow deficits. This case highlights the utility of SS-OCTA in the multimodal evaluation of patients with choroidal inflammation, and the potential for good visual recovery in patients treated for TB-SLC.
Collapse
Affiliation(s)
- Gayathri C Tummala
- University of Washington, Department of Ophthalmology, Seattle, WA 98104, USA
| | - Zhongdi Chu
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Jessica E Weinstein
- University of Washington, Department of Ophthalmology, Seattle, WA 98104, USA
| | - Ruikang K Wang
- University of Washington, Department of Ophthalmology, Seattle, WA 98104, USA.,Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Kathryn L Pepple
- University of Washington, Department of Ophthalmology, Seattle, WA 98104, USA
| |
Collapse
|