Multifocal serpiginoid choroiditis
(MSC) is an uncommon clinical entity from the group of infectious choroiditis
, which is characterized by sectoral nonperfusion of choriocapillaris with subsequent ischemia and dysfunction of retinal pigment epithelium and photoreceptor cells of the outer retina(1,2).
a) Early manifestation as diffuse choroiditis
(focal areas of subretinal fluid or bullous serous retinal detachment)
(8) The common causes of CSCR include pregnancy, subretinal neovascularization, optic disc colobomas, diabetic retinopathy, venous occlusions and choroiditis
is a rare eye disorder that predominantly affects women in their third to fifth decade.
approached this characterization of treatment-naive CNV after anti-VEGF treatment on a larger spectrum of retinal pathology (from naMD to neovascularized idiopathic macular telangiectasia or multifocal choroiditis
), also measuring the greatest linear dimension and area of these CNV.
(5,6,7,8,9) Atypical, bullous, or chronic type CSCR may be confused with other diseases that can cause intraocular inflammation such as Vogt-Koyanagi-Harada (VKH) disease, posterior scleritis, sympathetic ophthalmia, multifocal choroiditis
, and serpiginous choroiditis
1 0.9 Chart Showing the CD4 Count of Patients at Baseline CD4 count <50 cells/uL 21% 50-100 cells/uL 6% 100-200 cells/uL 11% >200 cells/uL 62% Note: Table made from pie chart.
Table 1 Classification of uveitis Type of uveitis Location State of inflammation Anterior Iris Iritis Ciliary body Anterior cyclitis Iris and ciliary body Iridocyclitis Intermediate Vitreous Vitritis Hyalitis Pars planitis Posterior Choroid Choroiditis
Retina Retinitis Neuroretinitis Choroid and retina Chorioretinitis Retinochoroiditis Pan-uveitis All of the above All of the above Table 2 Prednisolone acetate 1% Prednisolone sodium phosphate 0.1-0.5% Fluorometholone 0.1% Rimexolone 1% Loteprednol etabonate 0.5% Table 3 Immunosuppressive drugs Table 3 Class Examples Antimetabolites Azathioprine Methotrexate Mycophenolate mofetil Alkylating agents Cyclophosphamide Chlorambucil Antibiotics Cyclosporine Tacromimus Rapamycin Dapsone Adjuvants Bromocriptine Ketoconazole Colchicine
(13) Although visual problems were excluded as the cause for such a change, the disease's ocular manifestations are described as uveitis, vitritis, retinitis, retinal haemorrhage, choroiditis
, papilledema, optic atrophy, and keratitis.
Furthermore, Gabrielian and Hariprasad (8) described an immunocompetent patient with treated and stable nonocular disseminated coccidioidomycosis who showed development of new vitritis and choroiditis
8 weeks into high-dose fluconazole therapy; his intraocular disease resolved within 2-4 weeks of transition to voriconazole.
Inflammatory etiologies include uveitis-glaucoma-hyphema syndrome, sympathetic ophthalmia, sarcoidosis, pars planitis, multiple sclerosis, rheumatoid arthritis, birdshot chorioretinopathy, Behcet disease, Vogt-Koyanagi-Harada disease, sterile endophthalmitis, multifocal choroiditis
, and acute posterior multifocal placoid pigment epitheliopathy.
Active lesions present as gray-white foci of retinal necrosis with adjacent choroiditis
, vasculitis, hemorrhage, and vitritis.