Multimodal Imaging of Serpiginous Choroiditis

Area of Science:

• Ophthalmology
• Medical Imaging
• Retinal Diseases

Background:

• Serpiginous choroiditis is an inflammatory condition affecting the choroid and retina.
• Atypical presentations can mimic other chorioretinal diseases.
• Optical coherence tomography (OCT) and OCT angiography (OCTA) are crucial for diagnosis and monitoring.

Observation:

• A 35-year-old male presented with acute vision loss due to atypical serpiginous choroiditis.
• Fundoscopy revealed peripapillary and macular lesions; fluorescein angiography showed hypofluorescence.
• OCT demonstrated outer retinal layer hyperreflectivity and ellipsoid zone loss.

Findings:

• Initial treatment with oral prednisone improved visual acuity but led to recurrence upon discontinuation.
• Intravenous methylprednisolone followed by oral steroids and azathioprine resulted in sustained visual recovery and lesion resolution.
• OCT angiography of resolved lesions showed choriocapillaris inhomogeneity, a previously unreported finding.

Implications:

• OCTA reveals choriocapillaris changes in resolved serpiginous choroiditis, suggesting a potential mechanism for neovascularization.
• This case underscores the utility of OCT and OCTA in managing atypical serpiginous choroiditis.
• Azathioprine serves as an effective steroid-sparing agent for long-term disease control.