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Case Reports
. 2023 Apr 7;85(4):1286-1290.
doi: 10.1097/MS9.0000000000000548. eCollection 2023 Apr.

Role of multimodal imaging in differentiating unilateral APMPPE from unilateral Harada disease - a case report

Sadhana Sharma  1 , Ranju Kharel  1 , Sanket Parajuli  2 , Pratap Karki  1 , Sagun N Joshi  1
Affiliations
Case Reports

Role of multimodal imaging in differentiating unilateral APMPPE from unilateral Harada disease - a case report

Sadhana Sharma et al. Ann Med Surg (Lond). .

Abstract

Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is classified as a part of the spectrum of the white dot syndromes affecting the inner choroid and the outer retina. It is usually bilateral and affects young patients between the second and fourth decades. The authors report an unusual case of unilateral APMPPE mimicking Vogt-Koyanagi-Harada (VKH) disease where the fundus fluorescein angiography was instrumental in confirming the diagnosis.

Case presentation: A 35-year-old male presented with decreased visual acuity in the right eye for 3 days. Fundus examination revealed minimal vitritis, disc edema, and multifocal yellowish placoid lesions. Optical coherence tomography (OCT) showed the accumulation of subretinal fluid with subretinal septations closely mimicking VKH. Fundus fluorescein angiography depicted features of early hypofluorescence and late staining of the placoid lesions, suggesting APMPPE. Subretinal fluid partly resolved within a week, and visual acuity improved to 6/9(20/30) in the affected eye after the use of oral NSAIDS. Complete resolution of subretinal fluid was seen after 6 weeks.

Clinical discussion: The most distinguishing feature in this case is the unilateral presentation and macular serous retinal detachment with subretinal septa on OCT imaging, which are not the typical features in APMPPE but quite similar to the characteristic features in acute VKH disease.

Conclusion: APMPPE and acute VKH disease may share some overlapping clinical manifestations and imaging findings on OCT. APMPPE is a self-resolving disease, unlike VKH, and early diagnosis can avoid unnecessary administration of steroids and related side effects.

Keywords: Harada disease; acute posterior multifocal placoid pigment epitheliopathy; case report; inflammatory choroidopathy.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1
Figure 1
Multiple yellowish placoid lesions in the posterior pole with disc edema.
Figure 2
Figure 2
Normal fundus of left eye.
Figure 3
Figure 3
Resolved placoid lesions with pigmentary changes.
Figure 4
Figure 4
Spectral domain ocular coherence tomography of the right eye at initial presentation demonstrates subretinal fluid with bridging septa and disruption of inner/outer segment junction.
Figure 5
Figure 5
Normal optical coherence tomography findings of left eye.
Figure 6
Figure 6
Spectral domain ocular coherence tomography of the right eye after 1 week with significant resorption of subretinal fluid and irregularities of the retinal pigment epithelium layer.
Figure 7
Figure 7
Optical coherence tomography right eye after 2 weeks with resolving edema and reduced disruption of the ellipsoid layer and photoreceptor segments.
Figure 8
Figure 8
Optical coherence tomography right eye showing complete resolution of the subretinal fluid, with restoration of ellipsoid zone.
Figure 9
Figure 9
Laminar phase of fluorescein angiogram demonstrating early hypofluorescence of the placoid lesions.
Figure 10
Figure 10
Late phase of fluorescein angiogram demonstrating late staining of the placoid lesions.
See this image and copyright information in PMC

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