Choroiditis and choroidal neovascularization in acute disseminated encephalomyelitis

Area of Science:

• Ophthalmology
• Neurology
• Immunology

Background:

• Acute disseminated encephalomyelitis (ADEM) is a rare, immune-mediated demyelinating disease.
• Choroiditis and secondary choroidal neovascularization (CNV) are uncommon complications of ADEM.
• Recurrent CNV poses a significant challenge in managing ADEM-associated ocular manifestations.

Purpose of the Study:

• To report a unique case of bilateral CNV secondary to ADEM-associated choroiditis.
• To evaluate the efficacy of immunomodulatory therapy in preventing CNV recurrence.
• To discuss the role of systemic inflammation in the pathogenesis of ADEM-related CNV.

Main Methods:

• A 57-year-old male patient with a history of ADEM was diagnosed with bilateral CNV 6 years post-neurologic event.
• Initial treatment involved intravitreal bevacizumab and oral prednisone.
• Recurrence upon steroid tapering led to the initiation of mycophenolate mofetil as steroid-sparing immunomodulatory therapy.

Main Results:

• Intravitreal bevacizumab and oral prednisone initially controlled the CNV.
• CNV recurred during oral steroid tapering.
• Mycophenolate mofetil achieved sustained remission of CNV for 1.5 years without further antiangiogenic therapy.

Conclusions:

• This is the first reported case of choroiditis and secondary CNV associated with ADEM.
• Systemic immunomodulatory therapy, in conjunction with antiangiogenic agents, should be considered for recurrent CNV in ADEM.
• The findings support the hypothesis that ongoing inflammation plays a crucial role in the pathogenesis of ADEM-associated CNV.