Author: Raquel Soriano Gil (Spain)
Co-authors: Juan Antonio Sánchez Perea, Manuel Almarcha Menargues, María Victoria Navarro Abellán, Elena Rubio Velázquez
To describe the clinical and imaging features in multifocal choroiditis. We discuss the different clinical presentations, the differential diagnosis and therapeutic options in refractory cases.
Uveitis: Ophthalmology and Internal Medicine services. Morales Meseguer Hospital, Murcia, Spain.
We present a case report. Clinical data were gathered retrospectively from several visits during two years. The data included corrected visual acuity, anterior segment features, fundus examination, Autofluorescence, Fluorescence angiography (FA) and imaging findings of optical coherence tomography (OCT).
Fourty-six years old female with photophobia and decresed visual acuity in both eyes since two weeks. Other systemic symptoms and signs were not referred. In Ophthalmological examination, the best corrected visual acuity (BAVC) was 20/30 in both eyes. Intraocular pressure was normal. Slit lamp biomicroscopy of anterior segment showed Tyndall 2+ and keratic precipitates. Fundoscopy and Fluorescein Angiography (FA) of both eyes revealed vitritis, retinal vasculitis (phlebitis) and nerve head involvement with swelling and papillary blurred. No chorioretinal inflammatory lesions were visible in the initial presentation. The serological tests were negative and infection, neoplasic or systemic uveitic syndromes were excluded. The initial treatment was with topical and oral corticosteroids, but the non-response to the treatment leaded to immunosuppressive drug (Ciclosporina) addition. A year later, news findings were visible, yellow-white chorioretinal inflammatory lesions, small size, are visible in periphery of both eyes with symmetric involvement. On FA, acute lesions exhibit early hypofluorescence with late hyperfluorescent staining. Optical coherence tomography revealed a bilateral cystoid macular edema (CME) and neurosensorial detachment. Testing for HLA-A29 was negative. The suspect diagnosis was Choroiditis Multifocal and patient continued with anti-TNF therapy, Adalimumab. Finally, the disease was controlled and the BAVC was 20/25 in both eyes.
Choroiditis multifocal is a chronic, bilateral, panuveitis that affects especially myopic females between the third and fifth decade of life. The choroid, retinal pigment epithelium and outer retinal are primarily involved. The patients present periodic episodes of clinically evident anterior uveitis, vitritis and chorioretinal inflammatory lesions. Nevertheless, disc edema, retinal vasculitis and CME can also be seen. Once ruled out infection and neoplasm, the white dot syndromes are the principal diagnostic suspicion. Highlight in this case, the differential diagnosis between Choroiditis multifocal and Birdshot chorioretinopathy.
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