Title

REFRACTORY MULTIFOCAL CHOROIDITIS WITH NEOVASCULAR MEMBRANE

Summary

MMF,female, 45 years old, was admitted to the ophthalmology department of the Santa Casa de Misericordia of Belo Horizonte on May 2019 with a complaint of low visual acuity of the OS for 30 days. On admission: Visual acuity: 0.6 OD and 0.1 OS Biomicroscopy of both eyes showing calm eye, transparent cornea without RCA. RM of both eyes with increased vitreous cellularity, atrophic chorioretinal grayish white lesions arranged on the posterior pole and periphery, associated with vasculitis. Fluorescein angiography: contrast extravasation in the optic disc and multiple diffuse chorioretinal hyperfluorescent points in both eyes. OCT showed temporal subretinal material in the OS. Complete infectious screening showed VDRL of 1: 128 and FTA ABS +. Patient was referred to the other hospital for hospitalization and treatment for crystalline penicillin neurosyphilis for 14 days. After treatment, the patient had improvement in visual acuity with OD: 1.0 and OS:0.2. No signs of anterior uveitis and improvement of vitreitis. In October patient returned with visual impairment in the right eye. Av: 0.6 OD and 0.1 in OS Biomicroscopy without RCA, calm eyes. Fundoscopy with presence of well delimited lesion near the macula in the right eye. VDRL in Fall 1:32 Sulfamethoxazole + trimethoprim 800 / 160mg 12/12 hours and oral prednisone 40mg / day were started. After 15 days the patient maintained VA: 0.6 OD and 0.1 OS. When performing new OCT, subretinal fluid was found in OD suggestive of neovascular membrane. We opted to suspend Sulfamethoxazole + trimethoprim 800 / 160mg, reduce corticosteroid dose and perform intravitreal Anti VEGF in OD. Patient still awaiting intravitreal Anti VEGF in OD.

Area

CLINICAL CASE

Authors

Ana Gabriela Flori Chagas, Rafael Mourão Agostini, Luis Felipe Silva Alves Carneiro, Wilton Feitosa Araujo, Janaína Miranda Guimarães, Nadine Fernandes Silva, Letícia Torres Elias Silva, Brunelle Francino Nunes