Ayala Rodríguez Sofía C, Ramirez Marquez Estefania, Torres-Rosa Ángel G, Ramirez Marquez Jerome A, Boada Roberto, Oliver Armando L, Rodríguez-Rosa Ricardo E
University of Puerto Rico Medical Sciences Campus, Department of Ophthalmology, Paseo Dr. Jose Celso Barbosa, San Juan, PR, USA.
University of South Alabama, College of Medicine, Department of Radiology, Mobile, AL, USA.
Am J Ophthalmol Case Rep. 2024 Jul 20;36:102106. doi: 10.1016/j.ajoc.2024.102106. eCollection 2024 Dec.
To report on a case of the successful treatment of Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE) in a pediatric patient with a prior diagnosis of cerebral vasculitis.
A 16-year-old male with a prior diagnosis of cerebral vasculitis presented without ocular complaints. Visual acuity was 20/20, and color vision remained normal. Fundus examination revealed yellowish-white placoid lesions and retinal pigmented epithelial changes involving the posterior pole. A work-up including a rapid plasma reagin test, complete cell blood count, comprehensive metabolic panel, and urinalysis was within normal limits. A head computed tomography angiography without contrast and a brain magnetic resonance imaging scan were compatible with acute and past episodes of ischemia. Ancillary testing was compatible with an assessment APMPPE. Immunosuppressive and monoclonal antibody therapy resulted in the improvement and remission without residual neurologic deficits and with a BCVA of 20/20.
This case suggests that a diagnosis of cerebral vasculitis should prompt physicians to consider an ophthalmic evaluation that includes a dilated fundus exam, regardless of the presence or absence of ocular symptoms. Ophthalmic findings may affect the diagnostic processes, particularly concerning infectious and non-infectious etiologies, or potentially neoplastic diseases.
报告一例先前诊断为脑血管炎的儿科患者成功治疗急性后极部多灶性鳞状色素上皮病变（APMPPE）的病例。
一名先前诊断为脑血管炎的16岁男性患者，无眼部不适症状。视力为20/20，色觉正常。眼底检查发现后极部有黄白色鳞状病变及视网膜色素上皮改变。包括快速血浆反应素试验、全血细胞计数、综合代谢指标和尿液分析在内的检查均在正常范围内。头颅计算机断层血管造影（无造影剂）和脑部磁共振成像扫描结果与急性和既往缺血发作相符。辅助检查结果与APMPPE的评估相符。免疫抑制和单克隆抗体治疗使病情得到改善并缓解，无残留神经功能缺损，最佳矫正视力为20/20。
该病例表明，无论有无眼部症状，脑血管炎的诊断都应促使医生考虑进行包括散瞳眼底检查在内的眼科评估。眼科检查结果可能会影响诊断过程，尤其是在涉及感染性和非感染性病因或潜在肿瘤性疾病方面。
