Title

ACUTE POSTERIOR MULTIFOCAL PLACOID PIGMENT EPITELIOPATHY (APMPPE) COMPLICATING WITH CHOROIDAL NEOVASCULARIZATION: CASE REPORT

Introduction

Female, 25 year old, presenting 10 days of worsening of vision in both eyes. No record of ocular trauma, pathologies or surgeries. Visual acuity was 0,7 and 0,1 in the right and left eyes, respectively. Pupillary exam and anterior segment biomicroscopy were normal. Fundus examination revealed clear vitreous and multiple yellow-white lesions in the posterior pole. Infectious and rheumatologic screenings were negative. SD-OCT showed dome-shapped lesions on the outer retina in both eyes, and subretinal fluid with foveal involvement in the left eye. Fluorescein angiography (FA) demonstrated early hypofluorescence and late hyperfluorescence by staining. Indocyanine Green showed early and late hypofluorescence. By exclusion, APMPPE was the final diagnosis. It was initiated oral prednisone 1mg/kg.

Methods

Case Report

Results

Patient continues in close monitoring. In case of worsening of the subretinal fluid, anti-VEGF intravitreal injection to manage the choroidal neovascular membrane in the left eye will be scheduled.

Discussion

APMPPE has a unknown etiology, associated with hypoperfusion of the choriocapillaris and lesion of the overlying retinal pigment epithelium. There is no sex predilection, occurring in youth as an acute onset of blurred vision or scotomas. Fundus examination may present with yellow-white lesions varying in size in the posterior pole that are represented in the OCT by dome-shapped lesions in the outer retina. Some conditions can present APMPPE-like lesions, such as syphilis, sarcoidosis and tuberculosis. Therefore, they should be ruled out before closing diagnosis. APMPPE can be observed, but oral corticosteroids should be considered if central macular involvement or cerebral vasculitis and Anti-VEGF intravitreal injections if presence of choroidal neovascular membrane. In summary, APMPPE should always be remembered as a possible disease, so that the patient can benefit better from early diagnosis and avoid possible serious complications such as choroidal neovascularization.

Keywords

APMPPE; White Dot Syndrome; Choroid Neovascularization

Area

CLINICAL CASE

Authors

ERICK CARNEIRO HOLANDA, ARTHUR PINHEIRO FAVARATO, PEDRO ALBUQUERQUE REBELLO, LUISA GRAVE GROSS, VICENTE HIDALGO RODRIGUES FERNANDES, DELMA REGINA GOMES HUARACHI, IURI CARDOSO SILVA, OSIAS FRANCISCO SOUZA