Multimodal Imaging of a Case of Monitoring of Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE): Long-Term Follow-Up.

Abstract

An 18-year-old male presented with bilateral vision loss, worsening over 10 days in the left eye and rapidly in the right eye following a suspected viral respiratory infection. On admission, his best corrected visual acuity (BCVA) was 0.9 in the right eye and 0.025 in the left. No inflammation was found in the anterior segment or vitreous body, but both eyes showed multiple yellow-white, plaque-like lesions in the retina and choroid, with foveal involvement in the left eye. Diagnostic tests revealed choriocapillaris flow deficits (optical coherence tomography angiography (OCTA)), hyperreflective changes in the outer retina and choroidal thickening (optical coherence tomography (OCT)), hypofluorescence and patchy hyperfluorescence (fluorescein angiography (FA)), hypoautofluorescence with peripheral hyperautofluorescence (fundus autofluorescence (FAF)), reduced a- and b-wave amplitudes (electroretinogram (ERG)), and scotomas with decreased retinal sensitivity (visual field (VF)). The presence of HLA-B15 and HLA-B35 antigens was confirmed. Treatment with oral methylprednisolone and intravenous acyclovir led to significant improvement within 1 day. BCVA improved to 0.9 in the right eye and 0.25 in the left, with further improvement to 0.9 and 0.5 9 days after discharge. Full visual recovery was achieved within 5 weeks. This case underscores the diagnostic value of OCTA and suggests a potential genetic predisposition linked to HLA-B15 and HLA-B35. It also highlights the effectiveness of methylprednisolone and acyclovir in APMPPE following a viral infection.