Acute multifocal placoid pigment epitheliopathy-like lesion as an early presentation of subacute sclerosing panencephalitis

Floegel, Ingrid; Haas, Anton; El-Shabrawi, Yosuf

doi:10.1016/s0002-9394(02)01849-4

Cited by 22 publications

(4 citation statements)

References 4 publications

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“…MV-induced pathology has also been observed in the retina and optic nerve, and some SSPE patients initially present with a loss of vision [90,91]. In one case, an initial diagnosis of an acute multifocal placoid pigment epitheliopathylike lesion was made, as a white infiltration of the macular area and papillary oedema were observed [92]. However, subsequently, progressive neurological defects were observed and the diagnosis was revised to SSPE.…”

Section: Blindness and MV Infectionmentioning

confidence: 99%

Morbilliviruses and human disease

Rima

Duprex

2005

The Journal of Pathology

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Morbilliviruses are a group of viruses that belong to the family Paramyxoviridae. The most instantly recognizable member is measles virus (MV) and individuals acutely infected with the virus exhibit a wide range of clinical symptoms ranging from a characteristic mild selflimiting infection to death. Canine distemper virus (CDV) and rinderpest virus (RPV) cause a similar but distinctive pathology in dogs and cattle, respectively, and these, alongside experimental MV infection of primates, have been useful models for MV pathogenesis. Traditionally, viruses were identified because a distinctive disease was observed in man or animals; an infectious agent was subsequently isolated, cultured, and this could be used to recapitulate the disease in an experimentally infected host. Thus, satisfying Koch's postulates has been the norm. More recently, particularly due to the advent of exceedingly sensitive molecular biological assays, many researchers have looked for infectious agents in disease conditions for which a viral aetiology has not been previously established. For these cases, the modified Koch's postulates of Bradford Hill have been developed as criteria to link a virus to a specific disease. Only in a few cases have these conditions been fulfilled. Therefore, many viruses have over the years been definitely and tentatively linked to human diseases and in this respect the morbilliviruses are no different. In this review, human diseases associated with morbillivirus infection have been grouped into three broad categories: (1) those which are definitely caused by the infection; (2) those which may be exacerbated or facilitated by an infection; and (3) those which currently have limited, weak, unsubstantiated or no credible scientific evidence to support any link to a morbillivirus. Thus, an attempt has been made to clarify the published data and separate human diseases actually linked to morbilliviruses from those that are merely anecdotally associated.

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Section: Blindness and MV Infectionmentioning

confidence: 99%

Morbilliviruses and human disease

Rima

Duprex

2005

The Journal of Pathology

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“…AMPPE may also involve CNS with a wide range of neurological sequelae, ranging from headaches, meningitis, cerebral venous thrombosis to stroke, or death. [5][6][7][8][9] Cerebral vasculitis has been claimed the underlying cause of CNS involvement. [5][6][7][8][9] Despite association with viral infections and weak correlation to certain HLA haplotypes (HLA-DR2, HLA-B7), 10 the etiology of AMPPE remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Neurological Symptoms Associated with Acute Multifocal Placoid Pigment Epitheliopathy: Treatment Dilemma and Diagnostic Issues

Oleszczuk¹,

Saeed²

2013

Seminars in Ophthalmology

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Acute multifocal placoid pigment epitheliopathy (AMPPE) is thought to be caused by vasculitis of the choroid. Central nervous system involvement is rare. We report a case of a 28-year-old male who developed blurred vision (6/12 OD, 6/24 OS). Past medical history involved non-specific viral meningitis treated with intravenous antibiotics and antivirals. Subsequently, the patient complained of recurrent headaches. Based on typical clinical findings and fluorescein angiogram, he was diagnosed with AMPPE. Visual disturbance resolved without any systemic treatment. Six months later, visual symptoms recurred and resolved spontaneously, but his headache continued. A few months later, the patient developed acute progressive neurological signs and symptoms necessitating inpatient admission. Lacunar infarcts in the CNS were found, which had not been noted in previous neuro-imaging studies. Cerebral vasculitis associated with AMPPE was diagnosed and treated with systemic steroids and immune suppression. Currently, the patient remains asymptomatic under joined care of an ophthalmologist and a neurologist.

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“…Since its original description ( 21 ), multiple infective etiologies with known neurotropism have been associated with APMPPE including adenovirus ( 5 , 6 ), measles ( 22 ), mumps ( 23 ), dengue virus ( 24 ), lyme disease ( 25 , 26 ), and tuberculosis ( 21 , 27 ). While viral neurotropism is widely known, the ability of bacteria such as Mycobacterium tuberculosis to also possess neurotropic capability is a relatively new discovery ( 28 ).…”

Section: Potential For Infective Etiologymentioning

confidence: 99%

Proposing a Neurotropic Etiology for Acute Posterior Multifocal Placoid Pigment Epitheliopathy and Relentless Placoid Chorioretinitis

et al. 2022

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PurposeTo reassess the underlying pathophysiology of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and relentless placoid chorioretinitis (RPC) through comparison with the non-inoculated eye of the von Szily animal model of neurotropic viral retinal infection.MethodsNarrative review.ResultsLiterature reports of isolated neurotropic viral entities and rising serological viral titers in APMPPE after presentation support a potential direct infective etiology. In general, viral transport along axons results in mitochondrial stasis and disruption of axoplasmic flow. Clinical manifestations of axoplasmic flow disruption in APMPPE/RPC may signify the passage of virus along the neuronal pathway. From a case series of 11 patients, we demonstrate a timely, spatial, and proportional association of optic disc swelling with APMPPE lesion occurrence. Signs within the inner retina appear to precede outer retinal lesions; and acute areas of outer nuclear layer (ONL) hyperreflectivity appear to be the result of coalescence of multiple hyperreflective foci resembling axonal spheroids (which occur as a consequence of axoplasmic disruption) and follow the Henle fiber layer neurons. Underlying areas of retinal pigment epithelium (RPE) hyper-autofluorescence follow ONL hyperreflectivity and may signify localized infection. Areas of apparent choriocapillaris hypoperfusion mirror areas of RPE/Bruch’s membrane separation and appear secondary to tractional forces above. Increases in choroidal thickness with lesion occurrence and focal areas of choriocapillaris hypoperfusion are observed in both APMPPE/RPC and the von Szily model.ConclusionsThe neurotrophic infection model provides significant advantages over the existing primary choriocapillaris ischemia hypothesis to account for the range of imaging signs observed in APMPPE and RPC.

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Acute multifocal placoid pigment epitheliopathy-like lesion as an early presentation of subacute sclerosing panencephalitis

Cited by 22 publications

References 4 publications

Morbilliviruses and human disease

Morbilliviruses and human disease

Neurological Symptoms Associated with Acute Multifocal Placoid Pigment Epitheliopathy: Treatment Dilemma and Diagnostic Issues

Proposing a Neurotropic Etiology for Acute Posterior Multifocal Placoid Pigment Epitheliopathy and Relentless Placoid Chorioretinitis

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