Title

ACUTE POSTERIOR MULTIFOCAL PLACOID PIGMENT EPITHELIOPATHY

Introduction

The condition was first described by Donald Gass 1968 who detected multiple spot like lesions at the level of the pigment epithelium in the acute phase, with spontaneous resolution and culminating in slight scarring The disease, which affects healthy young men and women, between the ages of 20 and 30 is associated with a viral prodrome It is generally bilateral and simultaneous, lasts between two and three weeks and is rarely recurrent. Affected patients report loss of central and paracentral vision, scotomas and photopsias. Episcleritis, aqueous humor cellularity and vitreitis may occur.

Methods

Fundoscopic lesions are placoid, cream colored, multifocal, of variable size, located at the posterior pole In more severe cases cystoid macular edema and optic disk edema may occur. At fluorescein angiography, recent lesions are hypofluorescent in the initial phases of the examination, and culminate in staining in the late phase In the late phase, we observe transmitted hyperfluorescence.The electrooculogram is altered or normal and the electroretinogram is normal. Its etiology is unknown but it is believed to be a response of the retinal pigment epithelium to various diseases such as tuberculosis, sarcoidosis, streptococcal diseases, syphilis, aseptic meningitis, cerebral vasculitis, juvenile rheumatoid arthritis, Lyme disease, AIDS, thyroiditis, regional enteritis, acute nephritis, adenovirus type 5 infection, erythema nodosum, episcleritis and retinal vasculitis.

Results

Differential diagnosis includes Birdshot, DUSN, and MEWDS chorioretinopathy, multifocal choroiditis and panuveitis non Hodgkin lymphoma and serpiginous choroiditis Systemic corticosteroid treatment is reserved for cases of cystoid macular edema and optic disk edema, and cyclosporin A should be administered preferentially to recurring cases.

Discussion

We conclude the diagnosis of choroidoretinal pathologies should be increasingly improved, by means of sophisticated laboratory or imaging examinations.

Keywords

EPITHELIOPATHY, MULTIFOCAL.

Area

CLINICAL CASE

Authors

CARLOS ROBERTO PINHEIRO