Serpiginous choroiditis in a herpes-positive patient

Viruses are one of the most common causes of infections involving the posterior segment of the eye. Viral infections can be congenital or acquired and can affect the retina, choroid, or optic nerve. Herpes simplex virus has been implicated in a number of posterior segment conditions, including serpiginous choroiditis (SC), which has generally been described as idiopathic.

A 57-year-old black female presented with decreased and distorted vision in both eyes, of 10 months duration. Funduscopy revealed radial, deep grayish lesions emanating off of the optic disc in a peripapillary fashion. The clinical appearance was suggestive of SC, which was confirmed by fluorescein angiography. Serologic testing was positive for herpes simplex virus and thus may suggest a causative link between the virus and the choroiditis.

SC has been historically cited as an idiopathic process. There have been only rare reports linking this process with a viral etiology. Laboratory testing and clinical work-up needs to be obtained in any patient suspected of having SC, to detect a viral etiology. Treatment of an underlying condition may lead to optimum resolution in these patients.