Title

SERPIGINOUS CHOROIDITIS

Summary

NAR, female, 47 years old, attended at Santa Casa in 2018 with reports of toxoplasmosis and low vision in both eyes for years. She had regular follow-up with an ophthalmologist and had already been treated with Bactrim several times with no improvement of symptoms. At examination she presented visual acuity of 20/40 OD, 20/50 OS. Anterior biomicroscopy had no changes and IOP was 12mmHg in both eyes. There were no signs of uveitis or inflammation. Fundoscopy showed chorioretinitis lesion with mobilization of peridiscal and macular pigment without signs of activity in OD and foveal atrophy in OS. The patient brought exams performed previously that showed lesions similar to those observed. Since fundoscopy were not typical of toxoplasmosis, further investigation was performed. Laboratory tests showed normal blood count, negative serology for toxoplasmosis, HIV, hepatitis, chickenpox, HTLV and syphilis. Chest X-ray was unchanged and induration by tuberculin test was 20mm. With the result of tuberculin test and history of contact with other people with tuberculosis we started treatment with rifampicin, isoniazid, pirazinamid and etambutol. After treatment she reported partial improvement of vision and BCAV was 20/30 OD and 20/40 OS. The presumptive diagnosis of serpiginous-like choroiditis following tuberculous infection was established due to the tuberculin result, compatible clinic, and improvement after therapy. In addition, the exclusion of other etiologies reinforces the diagnostic hypothesis. However, in 2019 the patient returns complaining of worsening of vision and new tests are performed. OCT showed macular atrophic lesions were more extensive and significant impairment of the external retina is observed. The worsening of the symptoms again brings into discussion the etiology of the lesions, taking into consideration the hypothesis of autoimmune disease. In this case the treatment should be different from the one previously proposed, based on immunosuppression.

Area

CLINICAL CASE

Authors

Letícia Torres Elias Silva, Rafael Mourão Agostini, Luis Felipe da Silva Alves Carneiro, Wilton Feitosa de Araújo, Gabriella Faria Lopes, Renata de Sousa Carneiro, Nadine Fernandes da Silva, Isabella Vieira de Oliveira