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Pathogenesis and Immunotherapy of Cogan’s Syndrome*
Published in George S. Eisenbarth, Immunotherapy of Diabetes and Selected Autoimmune Diseases, 2019
Barton F. Haynes, Nancy B. Allen, C. Christine Cox, Rex M. McCallum, L. Michael Cobo
Patient 1 had severe chorioretinitis progressing to blindness in the left eye, and uveitis, choroiditis, and subretinal neo vascular membrane fonnation around the macula in the right eye. Prednisone therapy was not efficacious in Patient 1, and because of the patient’s age, after laser treatment of the subretinal membrane it was elected to enter the patient on the cyclosporine A protocol rather than risk gonadal injury due to cyclophosphamide. Two weeks after the initiation of therapy with 5 mg/kg/d of cyclosporine A, vitreal inflammatory cells were markedly decreased. At follow-up at 18 months, the patient remained asymptomatic on 1 mg/kg cyclosporine A with diminished signs of vitreal and retinochoroidal inflammation, and no progression of the preexisting subretinal neovascular membrane.
The uveal tract
Published in Mary E. Shaw, Agnes Lee, Ophthalmic Nursing, 2018
Choroiditis is a condition manifesting itself as patches of inflammation on the choroid. On examination with an ophthalmoscope, fluffy white patches can be seen through a hazy vitreous humour. When these patches heal, they leave pigmented areas of scar tissue.
Posterior uveitis
Published in Gwyn Samuel Williams, Mark Westcott, Carlos Pavesio, Bushra Thajudeen, Practical Uveitis, 2017
Gwyn Samuel Williams, Mark Westcott
The spots that resemble multifocal choroiditis are themselves variable but on the whole tend to be less in number, more peripheral and have a predilection for the inferior retina. As in MCP the spots are creamy when active but form a pigmented scar when the inflammation has died down. Occasionally the presentation might mimic birdshot but the presence of pigment in any of the spots should raise the suspicion of sarcoidosis rather than birdshot as by definition birdshot lesions are unpigmented. A patient with posterior uveitis with spots should be asked about respiratory, joint and skin issues and if any exist a letter sent to the relevant specialty and a chest x-ray organised along with a serum ACE.
Coats like response in healed choroiditis
Published in Ocular Immunology and Inflammation, 2022
Saurabh Verma, Indrish Bhatia, Mousumi Banerjee, Vinod Kumar
A 35-year-old female diagnosed with healed choroiditis OU, presented with blurring of vision in the left eye since 1 month. Best-corrected visual acuity was 6/60 OD and 6/12 OS. The patient did not have any associated systemic illness and blood pressure and sugar levels were normal on examination. Clinical examination revealed normal anterior segment and multiple healed choroiditis patches in both the eyes (Figure 1a,c). In addition, intraretinal hard exudates and hemorrhages were noted along supero-temporal arcade in the left eye (Figure 1c). Fluorescein angiography (FA) was consistent with healed choroiditis in the right eye (Figure 1b) and revealed multiple aneurysmal dilatations along supero-temporal artery and its branches in the left eye [Figure 1d–f], which leaked in the late phase. There was no evidence of venous occlusion or inflammatory choroidal neovascularization. Systemic workup revealed a normal hemogram with a normal erythrocyte sedimentation rate and serum angiotensin-converting enzymelevels and a negative Mantoux test.Computed tomography (CT) scan of chest was within normal limits. A diagnosis of healed multifocal choroiditis OU with coats’-like change in the left eye was made. The patient underwent intravitreal Ozurdex OS and multiple sittings of laser photocoagulation over a period of 12 months. The exudation and hemorrhages increased initially (Figure 2a–d) and resolved gradually over a period of 18 months (Figure 3a–d) with improvement in vision to 6/9. The right eye status did not change.
Case report of post streptococcal multifocal choroiditis in a young pregnant female: A success story
Published in Ocular Immunology and Inflammation, 2022
Lyudmila Kishikova, Alastair Coulson, Divya Jacob, Ahmed Saad
Typically, patients with multifocal choroiditis complain of blurred vision, floaters, scotomas and photopsias as well as possible enlargement of their physiological blind spot. Clinical findings may include vitritis, multiple yellow lesions at the level of retinal pigment epithelium and choriocapillaris. The presence of intraocular inflammation in the form of uveitis or vitritis may have prognostic implications. However, our case highlights the acute progression of the disease and severe impact on the vision, with the absence of uveitis. Another unique challenge of our case is that the patient was in the early stages of pregnancy at presentation, which limits the potential immunosuppressive therapy options. The first-line treatment for Multifocal Choroiditis is systemic corticosteroid therapy.7 This may be used in combination with immunomodulatory therapy, which has shown to decrease the amount of inflammatory infiltration of the outer retina and subretinal space, and reduce the damage seen on multimodal imaging.5,8 However, even oral prednisolone has been linked to increased risk of intrauterine growth restriction, and several adverse pregnancy outcomes including preterm birth, preeclampsia, and gestational diabetes.9 This highlights the importance of considering the risks and benefits of this treatment option for patients, as well as multidisciplinary team involvement. Fortunately, the birth was at term and there have been no adverse effects observed in the newborn.
COVID-19 Vaccination and Bilateral Multifocal Choroiditis
Published in Ocular Immunology and Inflammation, 2021
Rujittika Mungmunpuntipantip, Viroj Wiwanitkit
Dear Editor, we would like to share ideas on “Bilateral Multifocal Choroiditis following COVID-19 Vaccination.1” Goyal and Annum noted that “The onset of ocular symptoms starting within one week following vaccination suggests an inflammatory or autoimmune …. Ophthalmologists should consider the option of autoimmune … as uveitis, following COVID-19 vaccination.1” The possible adverse effect of new COVID-19 vaccine is an interesting issue at present. Some vaccines, especially mRNA vaccine, are reported for possible association with triggering of autoimmunity. In the present case, the identification of autoimmunity might be a necessary clue for diagnosis. The multifocal choroiditis might be due to several reasons. There might also be other concurrent disorder such as infection causing choroiditis. A possible cause is the rheological disorder after vaccination. Choroiditis is a possible complication of hyperviscosity.2,3 For COVID-19 vaccine, a change of blood viscosity after vaccination is reported and if there is an excessive high viscosity post vaccination, it might cause several problems including to hyperviscosity.4 Hence, there might be bilateral multifocal choroiditis due to this pathological process.