Multifocal Choroiditis and Panuveitis - difficulties in diagnosis and treatment

Abstract

We present the case of a 49-year-old patient who was treated with Aripriprazole in context of Paranoid Schizophrenia. The patient had a history of numerous Panuveitis recurrences for the left eye, which led to a marked decrease of the vision VA-NLP and was diagnosed with Multifocal Choroiditis and Panuveitis for the right eye. The examination revealed VA of 20/ 200 for right eye, keratic precipitates, and vitritis. Fundus aspect of the right eye showed multiple discrete, ovoid, yellowish-grey lesions at the posterior pole and periphery, optic disc oedema was present. The Human leukocyte antigen typing of group A, ancillary investigation (OCT, Angiofluorography, B-mode ultrasonography) and fundus examination confirmed the diagnosis of Multifocal Choroiditis and Panuveitis but we did not exclude antipsychotic-related chorioretinopathy or a Birdshot-like Syndrome.

B-Scan Ultrasound Evaluation for Uveitis in Inflammatory Arthropathies: Systematic Review

“…Despite appearing to be useful in the anatomical assessment of ocular structures, sometimes inflammatory pathologies may not present changes detectable by the ultrasound technique, 13 , 17 requiring the use of other imaging tests to perform the diagnosis.…”

“…Among the articles reviewed, only 2 described vitreous opacity using the ultrasound technique. 10 , 16 All studies presented characteristics and diagnosis of retinal, choroidal, or posterior vitreous detachment 10 , 13 , 14 , 16 ; however, based on the 2 original articles, 10 , 16 one might think that there is a tendency to the thickening of ocular structures to be more common than the detachment of those structures, although this was not uncommon in the patients assessed.…”

“…A secondary finding evaluated in this review was the characterization of the main complications of these ocular inflammatory processes, which could be identified in 5 articles among those selected. 10 , 13 , 14 , 16 , 22 …”