Dados do Trabalho

Título

CHOROIDAL NEOVASCULARIZATION IN UNILATERAL ACUTE IDIOPATHIC MACULOPATHY ASSOCIATED WITH COXSACKIEVIRUS B2

Introdução

UAIM is usually a self-limiting condition, and there’s no evidence that any therapy interferes with the natural history of the disease, as visual acuity improves over weeks, although patients may developed late vision loss due to CNV. The absence of CNV at presentation does not assure that late CNV will not occur. Multimodal imaging is valuable to more accurately determine the presence and extent of the neovascular network and response to treatment during follow-up. Therefore, close follow-up with imaging modalities able to assess CNV is important.

Métodos

A 27-year-old woman complained of a sudden central visual field scotoma in her left eye two days before her presentation. The patient reported flu-like symptoms two weeks before her initial ophthalmic symptoms. She had a history of depression being treated with fluoxetine. On initial presentation, the best corrected visual acuity was 20/20 in the right eye (RE) and counting fingers at 2 meters in the left eye (LE). Intraocular pressure, pupillary reflexes, and anterior segment slit lamp examination were unremarkable in both eyes. A dilated fundus examination of the LE revealed a circular yellow lesion of 0.5-disc diameter at the fovea. Dilated fundus examination of RE was normal.
Multimodal imaging was performed (Figure 1). Coxsackie B2 IgM serology was positive, indicating recent infection. Toxoplasmosis, tuberculosis, syphilis and HIV tests were negative. These findings suggested unilateral acute idiopathic maculopathy (UAIM). Differential diagnostic hypothesis included multifocal choroiditis and punctate inner choroidopathy.

Resultados

The patient was closely observed without intervention and 2 months later the visual acuity improved to 20/50, with decrease in the submacular lesion. However, the patient presented a further decrease in visual acuity to 20/150 in the subsequent 2-month follow up, and a new multimodal imaging screening was ordered (Figure 2). The patient underwent an intravitreous Ranibizumab injection in the LE. After the injection, the OCT was repeated and there was partial decrement of the subretinal hyperreflective area and visual acuity improved to 20/30.

Conclusões

To the best of our knowledge, no previous reports were found linking coxsackie B2 infection with UAIM and CNV. The present case report demonstrates the importance of serial multimodal imaging to guarantee accurate diagnosis and effective therapy for patients with UAIM secondary to coxsackievirus infection, regardless of the virus variant involved.

Palavras Chave

UAIM, Choroidal Neovascularization, Coxsackievirus B2

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