Atypical presentation of macular serpiginous choroiditis masquerading as age related macular degeneration

To describe a case of macular serpiginous choroiditis (SC) masquerading as age related macular degeneration.

Multimodal imaging (MMI), including ultra-widefield fundus autofluorescence and fluorescein and indocyanine green angiography werer performed. Cross-sectional and en face optical coherence tomography (OCT) and OCT angiography (OCTA) facilitated the correct diagnosis of this masquerade condition.

A 57-year-old woman, with a history of long-standing vision loss in the left eye (OS), presented with acute vision loss in the right eye (OD). Color fundus photography showed a focal macular lesion central OD and an irregular atrophic macular scar central OS. OCT OD displayed large drusenoid lesions in the macula OD and a macular scar OS. OCTA showed evidence of inner choroidal ischemia central OD corresponding to the drusenoid lesions without shadow artifact OD. A diagnosis of macular serpiginous choroiditis was rendered OD and the patient was started on immunomodulatory therapy (IMT) including oral steroids and increasing dosages of mycophenolate therapy. After three months of follow-up, the visual acuity remarkably improved, the drusenoid lesions completely resolved on OCT, and choroidal ischemia completely regressed on OCTA OD.

Placoid disorders can masquerade as AMD. We present an unusual case of macular serpiginous choroiditis with new onset drusenoid lesions driven by inner choroidal ischemia on OCTA and with resolution following IMT. OCTA can be an invaluable tool to correctly diagnose placoid conditions which is essential to guide therapeutic considerations.