A CASE OF ACUTE RETINAL PIGMENT EPITHELIITIS

Title A CASE OF ACUTE RETINAL PIGMENT EPITHELIITIS
Author, Co-Author Alvaro Castillo, Kevin Kummerfeld, Deana Lum, Nicholas Chan
Topic
Year
2010
Day
Thursday
Program Number
105967
Room
Third Floor Foyer
Affiliation
VA Central California Health Care System, Fresno Medical Center
Abstract BACKGROUND: Acute retinal pigment epitheliitis (ARPE) is a rare retinal disease that presents in young, healthy patients. It is characterized by acute onset of blurry vision and scotomas accompanied by pigmentary changes within the macula and posterior pole. Resolution of symptoms typically occurs within 6-12 weeks, and there is recovery of vision to baseline without residual scotomas. The etiology of this condition has yet to be identified, although a viral or bacterial cause has been suggested. In this case, ARPE was diagnosed in a patient with a recent history of hand, foot, and mouth disease (HFMD).

CASE REPORT(S): A 36 year old male complains of acute onset of blurry vision and two blind spots in the right eye. The patient had no significant ocular history, medical history was significant for a recent infection of HFMD, and was not taking any medications. Incoming BCVA was 20/400 OD, 20/20 OS. Confrontation tests and anterior segment exam was unremarkable. Posterior segment exam of the right eye revealed two flat, discrete circular areas of pigment stippling surrounded by hypopigmentation in the central macula and within the superotemporal arcade. Fluorescein angiography (FA) revealed two hypofluorescent lesions with transmitted hyperfluorescence corresponding to the pigmented lesions and hypopigmented haloes. The patient was observed without treatment. At 1 month follow-up, vision was 20/20 OD. There was no change in the appearance of the retinal lesions.

CONCLUSIONS: In this case, the patient was diagnosed with ARPE based on characteristic FA results of transmission hyperfluorescence with no late leakage. Based on the patient’s age and symptoms, differential diagnoses can include central serous chorioretinopathy, multiple evanescent white dot syndrome, acute posterior multifocal pigment epitheliopathy, and acute idiopathic maculopathy. The only significant medical history was HFMD which has been implicated in other retinal diseases. No treatment is necessary as ARPE typically resolves within 12 weeks without treatment.
Affiliation of Co-Authors VA Central California Health Care System, Fresno Medical Center, VA Central California Health Care System, Fresno Medical Center
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