title: Tuberculosis-related choriocapillaritis (multifocal-serpiginous choroiditis): follow-up and precise monitoring of therapy by indocyanine green angiography.
abstract: To report the case of a patient initially diagnosed with acute posterior multifocal placoid pigment epitheliopathy (APMPPE), characterized by relentless evolution despite high-dose steroid therapy. An interferon-gamma release assay (IGRA) indicated a diagnosis of suspected tuberculous choriocapillaritis and the disease responded only to massive inflammation suppressive therapy and antibiotic therapy. Case report. Review of clinical features and investigational procedures. Smoldering relentless evolution and subsequent arrest of progression could be precisely monitored by indocyanine green angiography (ICGA). The patient did not recover after standard anti-tubercolosis (TB) therapy combined with corticosteroid. A fourth antibiotic had to be added in order to stop the progression of the retinal disease. In each case of choriocapillaritis such as APMPPE an infectious cause including TB has to be excluded making IGRA tests unavoidable. As the main structure involved is the choriocapillaris the most precise follow-up or monitoring is obtained with ICGA.
authors.affiliation: Centre for Specialized Ophthalmic Care (COS), 6, rue de Grotte, 1003 Lausanne, Switzerland.
authors.forename: Giulia
authors.initials: G
authors.lastname: De Luigi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mantovani
authors.forename: Marina
authors.initials: M
authors.lastname: Papadia
authors.forename: Carl P
authors.initials: CP
authors.lastname: Herbort
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000907:Antibodies, Bacterial / Q000032:analysis; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002196:Capillaries / Q000473:pathology*; D002829:Choroid / Q000098:blood supply* / Q000473:pathology; D002833:Choroiditis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D004396:Coloring Agents; D003937:Diagnosis, Differential; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005451:Fluorescein Angiography / Q000379:methods*; D005500:Follow-Up Studies; D005654:Fundus Oculi; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007208:Indocyanine Green; D000080364:Multifocal Choroiditis; D009169:Mycobacterium tuberculosis / Q000276:immunology*; D014657:Vasculitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D014792:Visual Acuity
chemical_list: D000907:Antibodies, Bacterial; D000995:Antitubercular Agents; D004396:Coloring Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D007208:Indocyanine Green