J.ophthalmol.(Ukraine).2022;5:54-64.

Pdf

http://doi.org/10.31288/oftalmolzh202255464

Received: 03.08.2022; Accepted: 22.08.2022; Published on-line: 27.10.2022


A case of acute posterior multifocal placoid pigment epitheliopathy: clinical analysis and differential diagnosis

N. V. Konovalova 1, N. I. Khramenko 1, O. V. Guzun 1, S. B. Slobodianyk 1, O. V. Kovtun 2 

1 SI "The Filatov Institute of Eye Diseases and Tissue Therapy of the NAMS of Ukraine)

2 Odesa National Medical University

Odesa (Ukraine)

TO CITE THIS ARTICLE: Konovalova NV, Khramenko NI, Guzun OV, Slobodianyk SB, Kovtun OV. A case of acute posterior multifocal placoid pigment epitheliopathy: clinical analysis and differential diagnosis. J.ophthalmol.(Ukraine).2022;5:54-64.    http://doi.org/10.31288/oftalmolzh202255464

 

Background: Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a rare inflammatory disease, and the differential diagnostic assessment is essential for its adequate treatment.

Purpose: To perform clinical analysis and differential diagnosis for a case of APMPPE.

Material and Methods: We present a case of a 26-year-old woman with APMPPE. The patient underwent an eye examination which included visual acuity assessment, refractometry, tonometry, perimetry, biomicroscopy, direct and indirect ophthalmoscopy, optical coherence tomography (OCT), fundus photography, and fluorescein angiography (FA). Endonasal electrophoresis was conducted in a routine manner using azithromycin, a macrolide antibiotic.

Results: OCT found numerous flat yellowish-white and grey-pink lesions in the posterior pole of the fundus at the level of the retinal pigment epithelium and choriocapillary layers. FA showed irregularly shaped non-fluorescent lesions, which began to exhibit faint fluorescence a few minutes after the dye injection. The differential diagnosis should include serpiginous choroiditis, Vogt-Koyanagi-Harada syndrome, geographical choroiditis, acute retinal pigment epitheliitis (Krill disease), and choroidal neoplasm.

Conclusion: Acute posterior multifocal placoid pigment epitheliopathy is an acute-onset disease. If the disease is suspected, a thorough history is essential, and the differential diagnosis should be performed for early treatment and referral to an appropriate specialist. Patients with this disease should be followed since recurrences can occur.

Keywords: acute posterior multifocal placoid pigment epitheliopathy, differential diagnosis, treatment

 

References 

1.Testi I, Vermeirsch S, Pavesio C. Acute posterior multifocal placoid pigment epitheliopathy (APMPPE). J Ophthalmic Inflamm Infect. 2021 Nov 1;11(1):31.

Crossref  PubMed

2.Gass JD. Acute posterior multifocal placoid pigment epitheliopathy.  Arch Ophthalmol. 1968 Aug;80(2):177–85.

Crossref  PubMed 

3.Jones NP. Acute posterior multifocal placoid pigment epitheliopathy. Br J Ophthalmol. 1995 Apr;79(4):384-9.

Crossref  PubMed

4.Saleh M. Placoid pigment epitheliopathy and serpiginous choroiditis. J Fr Ophtalmol. 2020 Feb;43(2):e55-e66.

Crossref  PubMed

5.Deutman AF, Lion F. Choriocapillaris nonperfusion in acute multifocal placoid pigment epitheliopathy. Am J Ophthalmol. 1977 Nov;84(5):652-7.

Crossref

6.Thomson SP, Roxburgh ST. Acute posterior multifocal placoid pigment epitheliopathy associated with adenovirus infection. Eye (Lond). 2003 May;17(4):542-4.

Crossref  PubMed

7.Augsten R., Pfister W., Königsdörffer E. Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and borreliosis. Klin Monbl Augenheilkd. 2009;226(6):512–513.

Crossref  PubMed

8. Borruat FX, Piguet B, Herbort CP. Acute posterior multifocal placoid pigment epitheliopathy following mumps. Ocul Immunol Inflamm. 1998 Sep;6(3):189-93.

Crossref  PubMed

9.Hsu CT, Harlan JB, Goldberg MF, Dunn JP. Acute posterior multifocal placoid pigment epitheliopathy associated with a systemic necrotizing vasculitis. Retina. 2003 Feb;23(1):64-8.

Crossref  PubMed

10.Van Buskirk EM, Lessell S, Friedman E. Pigmentary epitheliopathy and erythema nodosum.  Arch Ophthalmol. 1971 Mar;85(3):369-72.

Crossref  PubMed

11.Vasseneix C, Aouidid S, Brasseur G, Quintyn JC. [Multifocal placoid pigment epitheliopathy as a manifestation of ophthalmological sarcoidosis]. J Fr Ophtalmol. 2007 May;30(5):e12. French.

Crossref 

12.Wolf MD, Folk JC, Panknen CA, Goeken NE. HLA-B7 and HLA-DR2 antigens and acute posterior multifocal placoid pigment epitheliopathy. Arch Ophthalmol. 1990 May;108(5):698-700.

Crossref  PubMed

13.Kraemer LS, Montgomery JR, Baker KM, Colyer MH. Acute posterior multifocal placoid pigment epiteliopathy after immunization with multiple vaccines. Retin Cases Brief Rep. 2022 Jan 1;16(1):16-19.

Crossref  PubMed

14.Brézin AP, Massin-Korobelnik P, Boudin M, et al. Acute posterior multifocal placoid pigment epitheliopathy after hepatitis B vaccine. Arch Ophthalmol. 1995. 1995 Mar;113(3):297-300.

Crossref  PubMed

15.Mendrinos E., Baglivo E. Acute posterior multifocal placoid pigment epitheliopathy following influenza vaccination. Eye. 2010;24(1):180–181.

Crossref  PubMed

16.O'Halloran HS, Berger JR, Lee WB, et al. Acute multifocal placoid pigment epitheliopathy and central nervous system involvement: nine new cases and a review of the literature. Ophthalmology. 2001 May;108(5):861-8.

Crossref

17.Spaide RF, Yannuzzi LA, Slakter J. Choroidal vasculitis in acute posterior multifocal placoid pigment epitheliopathy. Br J Ophthalmol. 1991 Nov; 75(11): 685–7.

Crossref  PubMed

18.Algahtani H, Alkhotani A, Shirah B. Neurological Manifestations of Acute Posterior Multifocal Placoid Pigment Epitheliopathy. J Clin Neurol. 2016 Oct;12(4):460-467.

Crossref  PubMed

19.Browne AW, Ansari W, Hu M, et al. Quantitative Analysis of Ellipsoid Zone in Acute Posterior Multifocal Placoid Pigment Epitheliopathy. J Vitreoretin Dis. 2020 Jun 1;4(3):192-201.

Crossref  PubMed

20.Raven ML, Ringeisen AL, Yonekawa Y, Stem MS, Faia LJ, Gottlieb JL. Multimodal imaging and anatomic classification of the white dot syndromes. Int J Retina Vitreous. 2017 Mar 20;3:12.

Crossref  PubMed

21.Goldenberg D, Habot-Wilner Z, Loewenstein A, Goldstein M. Spectral domain optical coherence tomography classification of acute posterior multifocal placoid pigment epitheliopathy. Retina. 2012 Jul;32(7):1403-10.

Crossref  PubMed

22.Lee GE, Lee BW, Rao NA, Fawzi AA. Spectral domain optical coherence tomography and autofluorescence in a case of acute posterior multifocal placoid pigment epitheliopathy mimicking Vogt-Koyanagi-Harada disease: case report and review of literature. Ocul Immunol Inflamm. 2011;19(1):42–47.

Crossref  PubMed

23.Heiferman MJ, Rahmani S, Jampol LM, Nesper PL, Skondra D, Kim LA, Fawzi AA. Acute posterior multifocal placoid pigment epitheliopathy on optical coherence tomography angiography. Retina. 2017;37(11):2084–2094.

Crossref  PubMed

24.Kirkham TH, Ffytche TJ, Sanders MD. Placoid pigment epitheliopathy with retinal vasculitis and papillitis. Br J Ophthalmol. 1972 Dec;56(12):875-80.

Crossref  PubMed

25.Kawia AA, Wanga DZ, Kamal K, Kattaha JC. Cerebrovasc Dis. Kawi AA, Wang DZ, Kamal K, Kattah JC. A case of ischemic cerebral infarction associated with acute posterior multifocal placoid pigment epitheliopathy, CNS vasculitis, vitamin B(12) deficiency and homocysteinemia. Cerebrovasc Dis.  2004;18(4):338-9.

Crossref  PubMed

26.Hammer ME, Grizzard WS, Travies D. Death associated with acute, multifocal, placoid pigment epitheliopathy. Arch Ophthalmol. 1989 Feb;107(2):170-1.

Crossref  PubMed

27.Quillen DA, Davis JB, Gottlieb JL, et al. The white dot syndromes. Am J Ophthalmol. 2004;137(3):538–550.

Crossref  PubMed

28.Heimann H, Kellner U, Foerster MH. Atlas of Fundus Angiography. 1st Edition ed. Stuttgart, New York: Thieme, 2006

Crossref

29.Duker JS, Waheed NK, Goldman DR. Handbook of retinal OCT. 2nd Edition. Elsevier Science; 2021. 

30.Konovalova NV, Khramenko NI, Guzun OV, Slobodyanik SB, Kovtun AV, Urchenko LA. A case of Vogt-Kayanagi-Harada syndrome. Oftalmologiia Vostochnaia Evropa. 2020;10(2):260-75. Russian.

 

Disclosures 

Authour Contribution: Konovalova N V: Conceptualization, Project administration, Data Curation, Formal Analysis, Writing – original draft; Khramenko NI: Conceptualization, Investigation, Writing – review & editing; Slobodianyk SB: Data Curation, Writing – review & editing; Kovtun OV: Writing – original draft, Data Curation.

Conflict of Interest Statement: The authors state that they have no conflict of interest that might bias this work.