Apmppe Case Report
ACUTE POSTERIOR MULTIFOCAL PLACOID PIGMENT EPITHELIOPATHY (APMPPE)
SUMMARY
A 19 year-old Army active duty white male, presented to the optometry clinic with sudden onset of decreased vision and a constant area of central blurry vision in the right eye for 1½ weeks. The patient noted similar, less prominent symptoms in the left eye. Ocular examination revealed multiple circumscribed, flat, cream colored lesions in the posterior pole, originating from the macular area with presentation in the right eye greater than the left eye (OD>OS). Fluorescein Angiography (FA) demonstrated late staining of the lesions. A diagnosis of APMPPE was made. Final visual outcome was 20/25 –2 OD, 20/20 OS. No further ocular or systemic complications were noted.
CASE REPORT
Subjective/Objective
A 19 year-old Army active duty white male, presented to the optometry clinic with a sudden, painless onset of decreased vision, and a constant area of central blurry vision the right eye for 1½ weeks. The patient noted similar, less prominent visual symptoms in the left eye. The patient had not previously sought care for this condition, and had a negative history for trauma, headache, and recent illness. The patient, however, was a new Army recruit and had received multiple vaccinations prior to onset of symptoms. Best-corrected visual acuity was 20/150–1 OD, 20/20 OS. Pupils were equal, round, reactive to light with negative relative afferent pupillary defect (RAPD). Extraocular muscle examination revealed no restrictions OD, OS. Amsler grid revealed distortions superiorly with no view of the center dot OD, and no distortions or scotomas OS. Slit lamp examination (SLE) revealed clear lids and lashes, conjunctiva, cornea, and lens OD, OS. The anterior chamber was deep and quiet OD, OS. The iris was flat and intact OD, OS. Angles were grade 4 nasal and temporal OD, OS. Intra-ocular pressures were found to be 11mm Hg OD, OS. The
SUMMARY
A 19 year-old Army active duty white male, presented to the optometry clinic with sudden onset of decreased vision and a constant area of central blurry vision in the right eye for 1½ weeks. The patient noted similar, less prominent symptoms in the left eye. Ocular examination revealed multiple circumscribed, flat, cream colored lesions in the posterior pole, originating from the macular area with presentation in the right eye greater than the left eye (OD>OS). Fluorescein Angiography (FA) demonstrated late staining of the lesions. A diagnosis of APMPPE was made. Final visual outcome was 20/25 –2 OD, 20/20 OS. No further ocular or systemic complications were noted.
CASE REPORT
Subjective/Objective
A 19 year-old Army active duty white male, presented to the optometry clinic with a sudden, painless onset of decreased vision, and a constant area of central blurry vision the right eye for 1½ weeks. The patient noted similar, less prominent visual symptoms in the left eye. The patient had not previously sought care for this condition, and had a negative history for trauma, headache, and recent illness. The patient, however, was a new Army recruit and had received multiple vaccinations prior to onset of symptoms. Best-corrected visual acuity was 20/150–1 OD, 20/20 OS. Pupils were equal, round, reactive to light with negative relative afferent pupillary defect (RAPD). Extraocular muscle examination revealed no restrictions OD, OS. Amsler grid revealed distortions superiorly with no view of the center dot OD, and no distortions or scotomas OS. Slit lamp examination (SLE) revealed clear lids and lashes, conjunctiva, cornea, and lens OD, OS. The anterior chamber was deep and quiet OD, OS. The iris was flat and intact OD, OS. Angles were grade 4 nasal and temporal OD, OS. Intra-ocular pressures were found to be 11mm Hg OD, OS. The
References: 1. Kooragayala LM. Acute Multifocal Placoid Pigment Epitheliopathy. EMedicine Journal. 2009. 2. Durani K. Acute Posterior Multifocal Placoid Pigment Epitheliopathy. MERSI Ocular Immunology and Uveitis Foundation. 2008. 3. DeVries. Acute Posterior Multifocal Placoid Pigment Epitheliopathy with Cerebral Vasculitis: A Multisystem Granulomatous Disease. Arch Ophthalmol. 2006; 124: 910-913. 4. Vedantham V, Ramasamy K. Atypical Manifestations of Acute Posterior Multifocal Placoid Pigment Epitheliopathy. Indian J Ophthalmol. 2006; 54: 49-52. 5. Helene Masse et al. Mitoxantrone Therapy for Acute Posterior Multifocal Placoid Pigment Epitheliopathy with Cerebral Vasculitis. Case Reports in Medicine. 2009. 6. Tewari A, Eliott D. White Dot Syndromes. Emedicine Journal. 2007. 7. Boghani DC, Ali QK. Patient with Probable Side Effect of Hepatitis Vaccination. CME Journal Ophthalmol. 2000; 4(3): 86-87.