Title

MULTIFOCAL COROIDOPATHY: AN UNUSUAL CASE

Summary

A 70-year-old male patient was admitted to the ophthalmology department with chronic low visual acuity in both eyes with progressive worsening. Visual acuity of 0.15 in right eye and counting fingers in left eye. Biomicroscopy without alterations. IOP 14 in both eyes. Fundoscopy demonstrated extensive deep hypopigmented lesions in the posterior pole and small in the periphery. Two years earlier, he was consulted by an ophthalmologist who recorded visual acuity of 0.4 in both eyes and the presence of drusen on fundus. At the time, he received the hypothesis of non-exsudative AMD. We studied the patient with complementary exams. Fundus Autofluorescence demonstrated hyperautofluorescence areas in the bilateral macular region, interspersed with bilateral hypoautofluorescence areas. Angiography showed several hyperfluor points in the posterior pole and in the periphery, beginning in early phases and progressing in late phases. Green indocyanine angiography without evidence of plaques or hotspots, with presence of image suggestive of choroid hypermeability. Optical coherence tomography with presence of neurosensory retinal detachment in macular area, with extensive irregularity of external photoreceptor segments and thickened choroid. Similar findings were also found in the periphery. Optical coherence tomography angiography study showed no signs of subretinal neovascular membrane. Patient had a clinical history of nephrotic syndrome, extended investigation by the nephrology team. Renal biopsy showed findings suggestive of type I glomerulonephritis. Aetiological investigation has most likely been shown to be secondary to schistosomiasis. Although it is the main differential diagnosis, we consider it unlikely to be idiopathic multifocal central serous corioretinopathy. In our literature review, we found several records of choroidopathy related to type II glomerulonephritis, but not type I. We hypothesized that we are facing a disease not yet reported in the literature.

Area

CLINICAL CASE

Authors

Vicente Hidalgo Rodrigues Fernandes, Erick Carneiro Holanda, Delma Regina Gomes Huarachi, Iuri Cardoso Silva, Juliana Albano Guimarães, André Luís Ayres Fonseca, Osias Francisco Souza, Maurício Abujamra Nascimento