Unilateral Acute Posterior Multifocal Placoid Pigment Epitheliopathy

Nakajima, Noriko; Noda, Sachiko; Hayasaka, Seiji

doi:10.1159/000310688

Cited by 4 publications

(4 citation statements)

References 8 publications

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“…Single eye involvement with delayed contralateral presentation, as seen in this patient, is even more uncommon. Unilateral APMPPE has been noted in several patients 7,[11][12][13][14][15] . To the best of our knowledge, the patient described herein has the longest documented time of 31 months between initial onset of placoid lesions and fellow eye involvement.…”

Section: Discussionmentioning

confidence: 99%

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Unilateral acute posterior multifocal placoid pigment epitheliopathy (APMPPE) with delayed contralateral eye involvement

Mordechaev

Shakarov

Parikh

2023

Preprint

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Background: Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a rare presumed inflammatory chorioretinopathy characterized by creamy, yellow-white placoid lesions at the level of the retinal pigment epithelium (RPE). Unilateral cases often have fellow eye involvement within days to a few weeks. This report details a rare case of delayed contralateral APMPPE, in which unilateral lesion resolution was followed by contralateral eye involvement 31 months later. Case presentation: A 38-year-old woman presented with three days of blurry vision and photopsias in the right eye (OD). She endorsed a viral GI illness one month prior. Visual acuity was 20/25 − 2 OD and 20/20 − 1 in the left eye (OS). Examination revealed creamy, yellow-white placoid lesions in the posterior pole. Fluorescein angiography (FA) was notable for early hypofluorescence and late hyperfluorescence of the lesions, consistent with APMPPE. MRI and MRA brain were negative for cerebral vasculitis. She was treated with oral prednisone with complete resolution of her symptoms, vision, and lesion regression. She then presented 31 months later, with blurry vision OS and similar new creamy, yellow-white placoid lesions in the posterior pole OS. She endorsed receiving an influenza vaccine one month prior. FA again was notable for early hypofluorescence and late hyperfluorescence. She was diagnosed with APMPPE, this time involving the left eye, and was once again started on oral steroids with complete resolution. She denied any neurologic symptoms. Conclusions: APMPPE is an inflammatory vasculitis of the choroid, leading to hypoperfusion and ischemic injury of the RPE with subsequent lesion formation. APMPPE may be preceded by a viral prodrome or vaccination, both of which were seen in this case. Choroidal inflammation seen in APMPPE is therefore thought to stem from immune-mediated processes. Unilateral cases often have fellow eye involvement within days to a few weeks. Single eye involvement with delayed contralateral presentation, as seen in our patient, is rare. This case demonstrates that lesion resolution in one eye can be followed by contralateral eye involvement up to 31 months later, highlighting the importance of routine ophthalmic monitoring for patients with unilateral APMPPE.

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Section: Discussionmentioning

confidence: 99%

“…In a case report by Nakajima et al, unilateral APMPPE self-resolved two months after onset, and fundus exam did not reveal any recurrence in either eye on annual follow up 14 . Most recently, unilateral APMPPE with no contralateral involvement was identi ed in a COVID-19 patient 15 .…”

Section: Kutluturk Et Al Conducted Amentioning

confidence: 99%

Unilateral acute posterior multifocal placoid pigment epitheliopathy (APMPPE) with delayed contralateral eye involvement

Mordechaev

Shakarov

Parikh

2023

Preprint

View full text Add to dashboard Cite

show abstract

“…The longest time between initial onset and fellow eye involvement was eleven weeks [ 13 ]. In a case report by Nakajima et al, unilateral APMPPE self-resolved two months after onset, and fundus exam did not reveal any recurrence in either eye on annual follow up [ 14 ]. Most recently, unilateral APMPPE with no contralateral involvement was identified in a COVID-19 patient [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Unilateral acute posterior multifocal placoid pigment epitheliopathy (APMPPE) with delayed contralateral eye involvement

Mordechaev,

Shakarov,

Parikh

2024

BMC Ophthalmol

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Background Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a rare presumed inflammatory chorioretinopathy characterized by creamy, yellow-white placoid lesions at the level of the retinal pigment epithelium (RPE). Unilateral cases often have fellow eye involvement within days to a few weeks. This report details a rare case of delayed contralateral APMPPE, in which unilateral lesion resolution was followed by contralateral eye involvement 31 months later. Case presentation A 38-year-old woman presented with three days of blurry vision and photopsias in the right eye (OD). She endorsed a viral GI illness one month prior. Visual acuity was 20/25 -2 OD and 20/20 -1 in the left eye (OS). Examination revealed creamy, yellow-white placoid lesions in the posterior pole. Fluorescein angiography (FA) was notable for early hypofluorescence and late hyperfluorescence of the lesions, consistent with APMPPE. MRI and MRA brain were negative for cerebral vasculitis. She was treated with oral prednisone with complete resolution of her symptoms, vision, and lesion regression. She then presented 31 months later, with blurry vision OS and similar new creamy, yellow-white placoid lesions in the posterior pole OS. She endorsed receiving an influenza vaccine one month prior. FA again was notable for early hypofluorescence. She was diagnosed with APMPPE, this time involving the left eye, and was once again started on oral steroids with complete resolution. She denied any neurologic symptoms. Conclusions APMPPE is an inflammatory vasculitis of the choroid, leading to hypoperfusion and ischemic injury of the RPE with subsequent lesion formation. APMPPE may be preceded by a viral prodrome or vaccination, both of which were seen in this case. Choroidal inflammation seen in APMPPE is therefore thought to stem from immune-mediated processes. Unilateral cases often have fellow eye involvement within days to a few weeks. Single eye involvement with delayed contralateral presentation, as seen in our patient, is rare. This case demonstrates that lesion resolution in one eye can be followed by contralateral eye involvement up to 31 months later, highlighting the importance of routine ophthalmic monitoring for patients with unilateral APMPPE.

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“…Acute posterior multifocal placoid pigment epitheliopathy presents with central scotomata and PCS [9, 140, 214]. Binocular involvement is typical [9, 62].…”

Section: Disorders With Pcsmentioning

confidence: 99%