Multifocal choroidopathy syndrome: A case report

Abstract

Introduction. Multifocal choroidopathy syndromes are a group of rare disorders, which involve a primary pathologic process occurring at or near the level of the retinal pigment epithelium, with or without choriocapillaris involvement. The aetiology of multifocal choroidopathy syndrome is still unknown. A case report. We present a case of multifocal choroidopathy syndrome. A 54-year-old woman was referred to our department with blurred vision on both eyes, mild ocular pain, accompanied by metamorphopsia, floaters, scotomas and photopsia. The anterior segment examination showed small to medium size keratic precipitates, posterior synechiae, and iris atrophy. Mild to moderate aqueous inflammation with cells and flair was present in the anterior chamber. The fundus examination showed multiple small yellow-white spots, round-shaped changes located at the level of the retinal pigment epithelium and choriocapillaris. According to the fluorescein angiography the active lesions exhibited blockage of the early choroidal fluorescence followed by late staining. The old inactive lesions corresponded to the retinal pigment epithelium windows defects. The laboratory examination showed high level of blood glucose, C reactive protein, cholesterol HDL, LDL, triglycerides. According to the immunological examination the C3 component of complement was lower (0.630), as well as the C4 component of complement (0.158), and the immunological complex in blood was elevated (171). ELIZA test on viral infection showed Citomegalo viruses IgG positive, Herpes Simplex Virus IgG positive, Varichela Zoster Virus IgG positive. The results of human leucocyte antigen typization were human leucocyte antigen A1:A2, human leucocyte antigen A2:A24(9), human leucocyte antigen B1:B44(12), human leucocyte antigen B2:B60(40), human leucocyte antigen C1:Cw3, human leucocyte antigen C2:Cw5. The radiological examination of lungs, the Mantoux test, Treponemal serology, Toxocara and Toxoplasma serology, magnetic resonance of endocranium and orbit were also performed. The multiple viral infection, which was detected in our patient with immunological abnormalities pointed to an underlying autoimmune mechanism, possibly triggered by an infectious agent, a virus.