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Recurring meningoencephalitis in sinusitis-associated acute posterior multifocal placoid pigment epitheliopathy under

H Joswig1, C Flueckiger, A Infanger

  • 1Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.

BMJ Case Reports
|June 15, 2012
PubMed

Insights

Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) can cause rare neurological issues. Long-term immunosuppression with azathioprine may be needed to manage recurrent complications effectively.

Area of Science:

  • Ophthalmology
  • Neurology
  • Immunology

Background:

  • Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is an inflammatory eye condition.
  • Neurological complications associated with APMPPE are uncommon but can be severe.

Observation:

  • A 24-year-old male presented with subacute bilateral visual loss.
  • The diagnosis of APMPPE was confirmed via funduscopy and fluorescein angiography.
  • Recurrent meningitis and encephalitis occurred during prednisone tapering, leading to partial epileptic seizures.

Findings:

  • Chronic sinusitis was suspected as a potential trigger for the autoimmune process.
  • Long-term immunosuppressive therapy with azathioprine was initiated due to the complicated disease course.
  • Azathioprine facilitated successful prednisone tapering and maintained patient stability.

Implications:

  • This case highlights the potential need for prolonged immunosuppression in APMPPE management.
  • Early recognition and aggressive treatment are crucial for preventing recurrent neurological sequelae.
  • Understanding the autoimmune basis of APMPPE may guide future therapeutic strategies.

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