Cerebrospinal fluid abnormalities in acute posterior multifocal placoid pigment epithelialopathy

Two patients with acute posterior multifocal placoid pigment epithelialopathy also had cerebrospinal fluid pleocytosis and elevated protein levels. A 24-year-old white women had visual acuity of counting fingers in each eye. The cerebrospinal fluid contained 56 lymphocytes per cubic millimeter and a protein level of 48 mg/100 ml. When the retinopathy resolved, visual acuity returned to R.E.: 6/60 (20/200), AND L.E.: 6/9 (20/30). A 22-year-old white man had visual acuity of counting fingers bilaterally. The initial lumbar puncture showed 70 lymphocytes and a protein level of 76 mg/100 ml. A second cerebrospinal tab showed 64 lymphocytes and a protein level of 86 mg/100 ml. Final visual acuity was R.E.: 6/15 (20/50), and L.E.: 6/6 (20/20). Neither patient received treatment for this disorder. The findings of cerebrospinal fluid cells and elevated protein levels in acute posterior multifocal placoid pigment epithelialopathy probably represent a mild viral meningitis as part of a systemic viral infection that also involves the retinal pigment epithelium or choriocapillaris.