Acute posterior multifocal placoid pigment epitheliopathy (APMPPE)

Testi, Ilaria; Vermeirsch, Sandra; Pavésio, Carlos

doi:10.1186/s12348-021-00263-1

Cited by 17 publications

(19 citation statements)

References 54 publications

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“…Systemic steroids (1 mg/kg/day oral prednisolone) are generally initiated in the acute phase of APMPPE and continued until vision improvement. Glucocorticoids are suggested to cause retinal cell death through various pathways, which is why long term steroid use is not ideal and the steroids are typically tapered off over several weeks [ 15 ]. Eosinophil reduction with steroids is an inverse, dose-dependent relationship.…”

Section: Discussionmentioning

confidence: 99%

Challenges in managing a multifactorial eosinophilic pneumonia: daptomycin vs strongyloidiasis case report

2022

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Background Eosinophilia is defined as a blood eosinophil count > 500/mcL with etiology usually an allergic reaction or parasitic infection which can lead to serious organ damage. Case presentation A patient being treated for hardware infection develops eosinophilia while on daptomycin in the setting of a positive strongyloides antibody. The patient was on chronic steroids prior to admission for epitheliopathy which complicated care. The daptomycin was discontinued, ivermectin initiated to treat strongyloidiasis, and high dose steroids initiated simultaneously. Eosinophilia resolved and patient discharged home after two months in the hospital. Conclusion Multifactorial eosinophilia poses question of steroid harm in the setting of parasitic infection. Patient was treated for both strongyloides and daptomycin induced eosinophilia with improvement and discharge from the hospital.

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Section: Discussionmentioning

confidence: 99%

Challenges in managing a multifactorial eosinophilic pneumonia: daptomycin vs strongyloidiasis case report

2022

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“…APMPPE's pathogenesis is unknown, but it is often preceded by a viral prodrome [22]. Gonome et al reported a case of APMPPE with granulomatous lesions after in uenza vaccination.…”

Section: Discussionmentioning

confidence: 99%

A case of APMPPE-like panuveitis presenting with extensive outer retinal layer impairment following COVID-19 vaccination

Ogino

Namba

Iwata

et al. 2022

Preprint

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Background Vaccination against the worldwide pandemic coronavirus disease 2019 (COVID-19) is underway; however, some cases of newly onset uveitis after vaccination have been reported. We report a case of bilateral acute posterior multifocal placoid pigment epitheliopathy-like (AMPPE-like) panuveitis after COVID-19 vaccination in which the patient’s pathological condition was evaluated using multimodal imaging. Case presentation A 31-year-old woman experienced bilateral hyperemia and blurred vision starting 6 days after her second inoculation of the COVID-19 vaccination. At her first visit, her visual acuity was decreased bilaterally, and severe bilateral anterior chamber inflammation and bilateral scattering of cream-white placoid lesions on the fundus were detected. Optical coherence tomography (OCT) showed serous retinal detachment (SRD) and choroidal thickening in both eyes (OU). Fluorescein angiography (FA) revealed hypofluorescence in the early phase and hyperfluorescence in the late phase corresponding to the placoid legions. Indocyanine green angiography (ICGA) showed sharply marginated hypofluorescent dots of various sizes throughout the mid-venous and late phases OU. The patient was diagnosed with APMPPE and was observed without any medications. Three days later, her SRD disappeared spontaneously. However, her anterior chamber inflammation continued, and oral prednisolone (PSL) was given to her. Seven days after the patient’s first visit, the hyperfluorescent lesions on FA and hypofluorescent dots on ICGA partially improved; however, the patient’s best corrected visual acuity (BCVA) dropped to 0.7 OD and 0.6 OS, and the impairment of the outer retinal layer was broadly detected as hyperautofluorescent lesions on fundus autofluorescence (FAF) examination and as irregularity in or disappearance of the ellipsoid and interdigitation zones on OCT, which were quite atypical for the findings of APMPPE. Steroid pulse therapy was performed. Five days later, the hyperfluorescence on FAF had disappeared, and the outer retinal layer improved on OCT. Moreover, the patient’s BCVA recovered to 1.0 OU. Twelve months after the end of treatment, the patient did not show any recurrences. Conclusions We observed a case of APMPPE-like panuveitis after COVID-19 vaccination featuring some atypical findings for APMPPE. COVID-19 vaccination may induce not only known uveitis but also atypical uveitis, and appropriate treatment is required for each case.

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“…The OCT-A findings within the 6 × 6 mm window analyzed correlate well with the hypofluorescent zones demonstrated by ICGA. Furthermore, outer retinal alterations on SD-OCT co-localize with the zones of choriocapillaris drop-out on OCT-A [ 28 , 29 ]. OCT-A is useful as part of the multimodal imaging in the follow-up of APMPPE within its limited field of view and can play a more important monitoring role because it can be repeated easily as it is non-invasive.…”

Section: Use Of Oct-a In Clinical Practice For Specific Uveitis Condi...mentioning

confidence: 99%

Benefits and Limitations of OCT-A in the Diagnosis and Follow-Up of Posterior Intraocular Inflammation in Current Clinical Practice: A Valuable Tool or a Deceiver?

Herbort¹,

Papasavvas²,

Tuğal-Tutkun

2022

Diagnostics

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Purpose: Optical coherence tomography angiography (OCT-A) has been applied to uveitis and intraocular inflammation since its availability after 2014. The imaging of retinal and choroidal vascularization without the use of dyes was a major development and represented a potentially valuable tool in ocular research. In addition to such use, OCT-A is often put forward as being able to potentially replace invasive methods needing dye injection, such as fluorescein angiography (FA) and indocyanine green angiography (ICGA). The aim of this review was to establish whether OCT-A was sufficiently useful in everyday routine clinical practice to monitor disease evolution and to perform treatment adjustments to the extent that it could reliably replace the standard dye methods. Methods: Selective literature review and analysis of own data and experience. Results: OCT-A is a technologically high-grade imaging modality allowing to analyze retinal circulation in inflammatory diseases of the posterior pole with a high sensitivity useful for research purposes. However, there is no evidence that it reaches equal effectiveness in the routine management of posterior uveitis involving the retina. OCT-A is unable to show leakage. In choriocapillaritis involving pre-capillary vessels, it shows capillary drop-out but does not seem to have an advantage over ICGA except that it can be repeated easily, not being invasive, and so allows a closer follow-up. It is, however, less useful in end-choriocapillary non-perfusion, such as in MEWDS. For choroidal stromal inflammation, OCT-A is ill-suited as it only shows inconsistent secondary circulatory changes produced by choroidal foci. OCT-A seems to be useful in the diagnosis and follow-up of inflammatory chorioneovascularisation (iCNV), although dye exams are more precise in showing the activity of the iCNV. Conclusion: In summary, OCT-A is a very sensitive modality for the retinal circulation in uveitis for research purposes; it is sometimes useful for close follow of choriocapillary drop-out but not in end-capillary non-perfusion. Its use for monitoring purposes in stromal choroiditis, however, is questionable. Its claim to possibly replace classical angiographic work-up for the practical management of posterior uveitis is largely overrated.

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Acute posterior multifocal placoid pigment epitheliopathy (APMPPE)

Cited by 17 publications

References 54 publications

Challenges in managing a multifactorial eosinophilic pneumonia: daptomycin vs strongyloidiasis case report

Challenges in managing a multifactorial eosinophilic pneumonia: daptomycin vs strongyloidiasis case report

A case of APMPPE-like panuveitis presenting with extensive outer retinal layer impairment following COVID-19 vaccination

Benefits and Limitations of OCT-A in the Diagnosis and Follow-Up of Posterior Intraocular Inflammation in Current Clinical Practice: A Valuable Tool or a Deceiver?

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