De Luigi Giulia, Mantovani Alessandro, Papadia Marina, Herbort Carl P
Centre for Specialized Ophthalmic Care (COS), 6, rue de Grotte, 1003 Lausanne, Switzerland.
Int Ophthalmol. 2012 Feb;32(1):55-60. doi: 10.1007/s10792-011-9508-y. Epub 2012 Jan 17.
To report the case of a patient initially diagnosed with acute posterior multifocal placoid pigment epitheliopathy (APMPPE), characterized by relentless evolution despite high-dose steroid therapy. An interferon-gamma release assay (IGRA) indicated a diagnosis of suspected tuberculous choriocapillaritis and the disease responded only to massive inflammation suppressive therapy and antibiotic therapy. Case report. Review of clinical features and investigational procedures. Smoldering relentless evolution and subsequent arrest of progression could be precisely monitored by indocyanine green angiography (ICGA). The patient did not recover after standard anti-tubercolosis (TB) therapy combined with corticosteroid. A fourth antibiotic had to be added in order to stop the progression of the retinal disease. In each case of choriocapillaritis such as APMPPE an infectious cause including TB has to be excluded making IGRA tests unavoidable. As the main structure involved is the choriocapillaris the most precise follow-up or monitoring is obtained with ICGA.
报告一例最初诊断为急性后极部多灶性扁平色素上皮病变（APMPPE）的患者，其特点是尽管接受了高剂量类固醇治疗仍持续进展。一项干扰素-γ释放试验（IGRA）提示疑似结核性脉络膜毛细血管炎，该疾病仅对大剂量炎症抑制治疗和抗生素治疗有反应。病例报告。回顾临床特征和检查程序。通过吲哚青绿血管造影（ICGA）可以精确监测病情的隐匿性持续进展以及随后的进展停止情况。患者在标准抗结核（TB）治疗联合皮质类固醇治疗后未康复。必须添加第四种抗生素才能阻止视网膜疾病的进展。在每例脉络膜毛细血管炎如APMPPE中，必须排除包括TB在内的感染性病因，因此IGRA检测不可避免。由于受累的主要结构是脉络膜毛细血管，ICGA可提供最精确的随访或监测。
