[Posterior scleritis simulating acute posterior multifocal placoid pigment epitheliopathy]

Posterior scleritis is a rare but probably underdiagnosed process. The lesions may cause diagnostic confusion with other diseases such as intraocular tumors and orbital or cerebral involvement. In the case presented, posterior scleritis simulated acute posterior multifocal placoid pigment epitheliopathy.

A 43-year-old woman presented with a history of pain and eye redness with lid swelling in the left eye followed by visual deterioration. On fundus examination, there was disc and macular edema with multiple grayish-white placoid and deep chorioretinal lesions in the posterior pole. Fluorescein angiography was compatible with acute posterior multifocal placoid pigment epitheliopathy, but the inflammatory context was unusual in this disorder. An orbital computed tomographic scan and b-scan ultrasonography showed posterior scleral thickening and the diagnosis of posterior scleritis was made. Etiological investigations were negative. A pulse of corticosteroids was started and the patient's symptoms and signs improved on clinical and angiographic examination.

Posterior scleritis may present with a range of clinical findings. Its clinical features may simulate many other diagnoses such as acute posterior multifocal placoid pigment epitheliopathy. Management is different in each situation: abstention in acute posterior multifocal placoid pigment epitheliopathy and a high dose of corticosteroids or even immunosuppressive therapy in posterior scleritis.

This report shows that posterior scleritis must be evoked in patients with unilateral fundus appearance of acute posterior multifocal placoid pigment epitheliopathy associated with an inflammatory context. Ultrasonography or MRI must be carried out.