Fungal Infection in Patients with Serpiginous Choroiditis or Acute Zonal Occult Outer Retinopathy

Pisa, Diana; Ramos, Marta Illán; Garcia, Patrícia Carvalho; Escoto, Remberto; Barraquer, Rafael I.; Molina, Susana; Carrasco, Luís

doi:10.1128/jcm.02605-06

Cited by 34 publications

(14 citation statements)

References 38 publications

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“…A recent PCR study, however, has raised the possibility that Candida sp may cause SC. 133 In four of five patients with SC, Candida DNA, Candida antigens, and high serum titers of antibodies against Candida species were detected. 133 This has not been confirmed by other investigators.…”

Section: Etiology/pathogenesismentioning

confidence: 91%

“…2 Although likely there is an underlying autoimmune pathogenesis, the specific trigger for this localized ocular immune process remains unknown. 102,185 Recent studies using polymerase chain reaction (PCR) and interferon gamma release assay suggest that microorganisms may be the inciting agents, 13,14,65,105,106,133,135 either through active proliferation or through induction of an immune response against the microbes. Such an immune response may also target the uvea and retina through a process of molecular mimicry.…”

Section: Introductionmentioning

confidence: 99%

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Serpiginous Choroiditis and Infectious Multifocal Serpiginoid Choroiditis

Khanamiri

Rao

2013

Survey of Ophthalmology

172

120

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Serpiginous choroiditis (SC) is a posterior uveitis displaying a geographic pattern of choroiditis, extending from the juxtapapillary choroid and intermittently spreading centrifugally. The choroiditis involves the overlying retinal pigment epithelium, and the outer retina. This intraocular inflammation typically involves both eyes in otherwise healthy, middle-aged individuals with no familial or ethnic predilection. Pathogenesis is unclear; however, based on limited histopathologic studies, favorable response to immunosuppressive agents, and the absence of association with systemic or local infectious or noninfectious diseases, an organ-specific autoimmune inflammation seems likely to be the underlying process. Patients, particularly from tuberculosis-endemic regions, may present with fundus changes simulating SC, but show evidence of active tuberculosis and/or the presence of mycobacterial DNA in the aqueous humor. This has been referred to as serpiginous-like choroiditis, but we prefer the description multifocal serpiginoid choroiditis (MSC). We present the distinguishing features of SC and infectious multifocal serpiginoid choroiditis simulating SC. The distinction is crucial to avoid unnecessarily treating SC with antimicrobial agents. Advances in diagnostic and imaging modalities can help differentiate SC from MSC. Novel local and systemic treatment approaches improve the outcome and preserve vision in SC.

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Section: Etiology/pathogenesismentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Serpiginous Choroiditis and Infectious Multifocal Serpiginoid Choroiditis

Khanamiri

Rao

2013

Survey of Ophthalmology

172

120

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“…Further considerations included his viral hypothesis, 7 an immune-mediated process or toxic retinopathy, [8][9][10] or fungal infections. 11,12 Numerous therapies, including immunosuppressive agents, anti-inflammatory drugs, and antiviral therapy, used singularly and in combination have shown no proven evidence of benefit. 4,7,8,[12][13][14] Since the original report by Gass, 1 the described spectrum of changes in the fundus in numerous studies [3][4][5][15][16][17][18] has varied from a normal appearance to a severely damaged retina.…”

mentioning

confidence: 99%

“…11,12 Numerous therapies, including immunosuppressive agents, anti-inflammatory drugs, and antiviral therapy, used singularly and in combination have shown no proven evidence of benefit. 4,7,8,[12][13][14] Since the original report by Gass, 1 the described spectrum of changes in the fundus in numerous studies [3][4][5][15][16][17][18] has varied from a normal appearance to a severely damaged retina. Nonspecific chorioretinal signs of inflammation and the unknown etiology of the condition have led to difficulties in distinguishing AZOOR from other entities such as optic neuropathies, paraneoplastic diseases, autoimmune retinopathies, toxic degenerations, and infectious diseases, including diffuse unilateral subacute neuroretinitis, lymphoma, and a myriad of hereditary chorioretinal diseases (eg, retinitis pigmentosa).…”

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confidence: 99%

Acute Zonal Occult Outer Retinopathy

et al. 2014

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IMPORTANCE We describe the multimodal imaging in a group of patients showing a distinct clinical entity that best represents acute zonal occult outer retinopathy (AZOOR). OBJECTIVE To propose a classification of AZOOR based on clinical fundus and multimodal imaging. DESIGN, SETTING AND PARTICIPANTS A retrospective review of patients diagnosed as having AZOOR at 2 centers. After reviewing more than 400 cases diagnosed or referred to us as AZOOR or AZOOR complex, we assembled 30 cases that fit our current definition; (48 eyes) with a median age at diagnosis of 47 years (age range, 17-86 years) and a mean follow-up period of 39 months. Twenty patients were female. Eighteen patients had initially been seen with bilateral lesions, mostly asymmetric (4 cases were symmetric). Most patients had no remarkable medical or ocular history. The median visual acuity at the time of presentation was 20/25 (range, 20/20 to 20/400). MAIN OUTCOMES AND MEASURES Multimodal imaging, including fundus photography, fluorescein and indocyanine green angiography, fundus autofluorescence imaging, and corresponding eye-tracked spectral-domain coherence tomography imaging. RESULTS Each patient was initially seen with visual symptoms of photopsia and scotoma, and most had a detectable lesion in the fundus evident clinically or detected on multimodal imaging. The clinical appearance of the AZOOR lesions varied depending on their duration and location, but some features were characteristic, including a demarcating line of the progression at the level of the outer retina and a trizonal pattern of sequential involvement of the outer retina, retinal pigment epithelium, and choroid, as well as frequent zonal progression. Advanced cases of AZOOR demonstrated disruption of the inner and outer retina and severe damage or loss of the retinal pigment epithelium and the choroid. CONCLUSIONS AND RELEVANCE A specific definition of AZOOR based on multimodal imaging is proposed to help physicians distinguish it from other diseases of the posterior fundus, including white spot syndromes and autoimmune, hereditary, paraneoplastic, toxic, and other inflammatory retinopathies.

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“…Additionally, other infections like herpes viruses, Toxoplasma, Tularemia, Bartonella, and fungi have been associated with serpiginous choroiditis/MSC. [8][9][10][11][12] Noninfectious conditions like systemic lupus erythematosus and non-Hodgkin lymphoma also have been associated with serpiginous choroiditis. [13][14] While the strengths of these associations have not been clearly ascertained, it emerges that serpiginous choroiditis/MSC represents a common manifestation of several infectious and noninfectious etiologies.…”

mentioning

confidence: 99%