CASE OF THE MONTH: September 2022

A Young Male with Bilateral Placoid Choroioretinopathy

Elysse Tom, MD; Thanos Papakostas, MD

Exam:


Vision

  • OD sc: 20/25 -1
  • OS sc: 20/200 +1 ph 20/150

Pupils

  • 3 mm → 2 mm, brisk, round, no RAPD OU

Pressure

  • 13 OD
  • 15 OS

Motility and CVF full OU


Anterior Segment




Fundus photos



Placoid pigmentary lesions in the macula and peripapillary region OU. FAF revealed mottled hyperautofluorescence with hypoautofluorescent borders OU.

OCT






Scattered incomplete outer retinal and RPE atrophy OU

Fluorescein Angiography



Early hypofluorescence/blockage, late hyperfluorescence/staining OU

Differential diagnosis:

  • Serpiginous choroiditis
  • APMPPE
  • Ampiginous choroiditis
  • Multifocal choroiditis
  • Serpiginous-like tuberculosis choroiditis
  • Presumed ocular histoplasmosis
  • Syphilis
  • Toxoplasmosis
  • Sarcoidosis

Workup

  • MRI brain and orbits with and without contrast -normal
  • ANA - negative
  • ACE - normal
  • ANCA - negative
  • HLA-B27 - negative
  • FTA-ABS - Nonreactive
  • Syphilis IgG - nonreactive
  • Quantiferon Gold -positive



References

1. Gupta V, Gupta A, Arora S, Bambery P, Dogra MR, Agarwal A. Presumed tubercular serpiginouslike choroiditis: clinical presentations and management. Ophthalmology. 2003 Sep;110(9):1744-9. doi: 10.1016/S0161-6420(03)00619-5. PMID: 13129872.


2. Vasconcelos-Santos DV, Rao PK, Davies JB, Sohn EH, Rao NA. Clinical Features of Tuberculous Serpiginouslike Choroiditis in Contrast to Classic Serpiginous Choroiditis. Arch Ophthalmol. 2010;128(7):853–858. doi:10.1001/archophthalmol.2010.116


3. Bansal R, Gupta A, Gupta V, Dogra MR, Sharma A, Bambery P. Tubercular serpiginous-like choroiditis presenting as multifocal serpiginoid choroiditis. Ophthalmology. 2012 Nov;119(11):2334-42. doi: 10.1016/j.ophtha.2012.05.034. Epub 2012 Aug 11. PMID: 22892153.