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Acute posterior multifocal placoid pigment epitheliopathy in connection with acute nephritis
1Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland.
Abstract:
A relationship between acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and systemic infections has been suggested. This report presents a case of APMPPE in connection with acute nephritis in a previously healthy man. The disease started with arthralgia, headache, fever, malaise, and lymphadenopathy. During the following 2 weeks, signs of mild nephritis developed. At the same time the patient noticed acute decrease in vision; the visual acuity being 0.08 (20/250) in both eyes. Mild anterior uveitis and areas of pigment epithelial swelling at the posterior pole corresponding to the picture of APMPPE were observed. Four weeks later, the fundus lesions had healed leaving some pigment epithelial atrophy and pigment dispersion in the macula, and the visual acuity was 0.8 (20/25) in the right and 1.0 (20/20) in the left eye. No systemic therapy was given. This case gives support to the theory of general vasculitis as a cause of APMPPE.
Insights
Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) can be linked to systemic infections. A case study shows APMPPE occurring with acute nephritis, suggesting a potential link to general vasculitis.
Area of Science:
- Ophthalmology
- Nephrology
- Rheumatology
Background:
- A potential association between acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and systemic infections has been previously hypothesized.
- This case report details an instance of APMPPE occurring concurrently with acute nephritis in an otherwise healthy male patient.
Observation:
- The patient presented with systemic symptoms including arthralgia, headache, fever, malaise, and lymphadenopathy.
- Within two weeks, symptoms of mild nephritis emerged, alongside a sudden and significant decrease in visual acuity to 0.08 (20/250) in both eyes.
- Ophthalmic examination revealed mild anterior uveitis and characteristic pigment epithelial swelling in the posterior pole, consistent with APMPPE.
Findings:
- The fundus lesions associated with APMPPE showed healing over a four-week period, resulting in residual pigment epithelial atrophy and macular pigment dispersion.
- Visual acuity improved significantly to 0.8 (20/25) in the right eye and 1.0 (20/20) in the left eye post-healing.
- No specific systemic therapy was administered during the observation period.
Implications:
- This case provides further evidence supporting the theory that APMPPE may be caused by a generalized vasculitic process.
- The co-occurrence of APMPPE and acute nephritis highlights the potential systemic nature of conditions affecting the retinal pigment epithelium.
- Further research into the link between infectious agents, vasculitis, and APMPPE is warranted.