Kitamura Yuta, Oshitari Toshiyuki, Kitahashi Masayasu, Baba Takayuki, Yamamoto Shuichi
Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Japan.
Department of Ophthalmology, International University of Health and Welfare, School of Medicine, Japan.
Case Rep Ophthalmol Med. 2019 Jul 9;2019:9217656. doi: 10.1155/2019/9217656. eCollection 2019.
A 17-year-old male presented with acute bilateral paracentral scotomata and blurred vision. Funduscopic examination showed bilateral macular serous retinal detachment and yellow-white placoid lesions at the level of retinal pigment epithelium. OCT study showed typical VKH disease findings with marked choroidal thickening and macular serous retinal detachment partly with subretinal septa in both eyes. FA demonstrated hypofluorescence at the placoid lesions in the early phase and hyperfluorescence in the late phase. Laboratory investigation showed negative result for HLA-DR4 serotype and the patient's cerebrospinal fluid test values were within normal range. We made the diagnosis of APMPPE from these results. At 2-month follow-up without the use of corticosteroids, OCT reexamination showed complete amelioration of subretinal fluid in both eyes. Patchy pigmentary lesions also resolved clinically with partial chorioretinal scars. The results in this case suggested OCT findings in APMPPE patients could be similar to characteristic features usually found in acute VKH disease. We recommend comprehensive assessments such as FA, cerebral spinal fluid analysis, and HLA typing which help in leading proper diagnosis.
一名17岁男性患者出现急性双侧旁中心暗点和视力模糊。眼底检查显示双侧黄斑区浆液性视网膜脱离以及视网膜色素上皮层的黄白色类脂质性病变。光学相干断层扫描（OCT）研究显示典型的Vogt-小柳-原田（VKH）病表现，双眼脉络膜显著增厚，黄斑区浆液性视网膜脱离，部分伴有视网膜下间隔。荧光素眼底血管造影（FA）显示类脂质性病变在早期呈低荧光，晚期呈高荧光。实验室检查显示HLA-DR4血清型结果为阴性，患者脑脊液检测值在正常范围内。根据这些结果我们诊断为急性后极部多发性鳞状色素上皮病变（APMPPE）。在未使用皮质类固醇的2个月随访中，OCT复查显示双眼视网膜下液完全吸收。斑片状色素沉着性病变在临床上也消退，伴有部分脉络膜视网膜瘢痕。该病例结果提示APMPPE患者的OCT表现可能与急性VKH病通常所见的特征相似。我们建议进行全面评估，如FA、脑脊液分析和HLA分型，这有助于做出正确诊断。
