Topic outline

  • Grand Rounds

    A patient presented with one week of blurred vision. He noted a concomitant headache and cold symptoms as well. He had a history of IV drug use 10 days prior. His visual acuity was 20/100 in the right eye and 20/20 in the left eye. Examination demonstrated anterior chamber cell in both eyes as well as vitritis. The fundus demonstrated confluent creamy yellow-white colored placoid lesions in the posterior pole. Optical coherence tomography demonstrated outer retinal disruption. Autofluorescence demonstrated multiple posterior pole lesions with hypoautofluorescence in the center and a hyperautofluorescent rim. Fluorescein angiography showed early hypofluorescence and later hyperautofluorescence. A laboratory work up including for syphilis and tuberculosis was negative. Magnetic resonance imaging of the brain and orbits as well as an angiogram of the cerebral vasculature were normal. A diagnosis of acute posterior multifocal placoid pigment epitheliopathy was made. The patient was started on an oral corticosteroid taper. Two weeks later, his vision in the right eye recovered from 20/100 to 20/20. Optical coherence tomography demonstrated partial reconstitution of the outer retina.

    Presentation Date: 10/21/2021
    Issue Date: 02/25/2022