Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE): A Case Report

Abstract

Case Report A 46 year old male patient presented with chief complaint of blurring of vision in the left eye since one week which was sudden in onset and painless, progressive in nature. He had mild fever and malaise one week back which responded to anti-pyretics. He had a history of cardiac stenting and was on tablet aspirin. The patient had no personal or family history of eye disease. The best corrected visual acuity was 6/6, N6 in right eye and 6/60, N24 in left eye. Color vision was normal in the right eye, but abnormal in the left eye. On examination, the anterior segment was normal and had no evidence of anterior uveitis in both eyes. Fundus examination showed multiple, sub-retinal, yellowishwhite placoid lesions, predominantly at the posterior pole in both the eyes and there was left eye macular oedema on stereoscopic examination by 90D lens (Figure 1, 2). Optical Coherence Tomography (OCT) of the left eye macula demonstrated serous detachment of the neuroretina, with free fluid between the neuroretina and the retinal pigment epithelium (RPE). Central macular thickness (CMT) was 527 μm (Figure 3), whereas, the right eye was normal and Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) affects young to middle-aged adults of both genders equally and ocular manifestations are often preceded by flu-like illness. Symptoms of the disease include acute vision loss, associated with central and paracentral scotoma. Impairment of vision is usually bilateral, but may be asymmetric. We report a case of a 46 year old male patient who presented to us with blurring of vision in the left eye since one week. Fundus examination of both eyes showed sub-retinal yellowish-white placoid lesions, predominantly at the posterior pole. Optical Coherence Tomography of the left eye macula revealed macular oedema. Fundus fluorescein angiography (FFA) of both eyes showed early hypofluorescence and late hyperfluorescence.