title: Multifocal choroiditis with panuveitis in an 8-year-old boy with long-standing idiopathic acute anterior uveitis.
abstract: OBJECTIVE
  To report successful treatment of a rare case of sight-threatening pediatric multifocal choroiditis with panuveitis (MFCPU) and the use of electrophysiology to confirm return of macular function.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  An 8-year-old boy with a history of bilateral recurrent non-juvenile idiopathic arthritis acute anterior uveitis (AAU) presented with new-onset blurry vision and floaters in both eyes. Visual acuity had deteriorated to 20/200 right eye and 20/100 left eye. Cells were observed in the anterior chamber and vitreous of both eyes. Ophthalmoscopy showed multiple active small cream-colored chorioretinal lesions and cystoid macular edema (CME) in both eyes in the absence of systemic disease, suggestive of idiopathic MFCPU. Successful rapid visual recovery and resolution of CME confirmed by spectral-domain optical coherence tomography (SD-OCT) was achieved with prompt intensive systemic steroid therapy followed by early introduction of methotrexate. After 9 months, his visual acuities improved to 20/32, and pattern reversal visual evoked potentials and 19 hexagon multifocal electroretinography posttreatment were normal, showing recovery of macular function.
  
  
  CONCLUSIONS
  Multifocal choroiditis with panuveitis is rare in children and has not been documented in the presence of previous longstanding recurrent AAU. Onset of floaters in children should alert the clinician to early stages of posterior pole involvement and progression to reduction in vision due to CME requires prompt aggressive steroid therapy monitored by clinical examination, SD-OCT, and electrophysiology, followed by early introduction of immunosuppressive drugs for long-term stability and to avoid steroid-induced adverse effects in children.
authors.affiliation: Department of Pediatric Ophthalmology, Alder Hey Children's NHS Foundation Trust, Liverpool - UK.
authors.forename: Andre
authors.initials: A
authors.lastname: Grixti
authors.affiliation: Department of Pediatric Ophthalmology, Alder Hey Children's NHS Foundation Trust, Liverpool - UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Hagan
authors.affiliation: Department of Pediatric Ophthalmology, Alder Hey Children's NHS Foundation Trust, Liverpool - UK.
authors.forename: Harish
authors.initials: H
authors.lastname: Nayak
authors.affiliation: Department of Pediatric Ophthalmology, Alder Hey Children's NHS Foundation Trust, Liverpool - UK.
authors.forename: Arvind
authors.initials: A
authors.lastname: Chandna
mesh_terms: D000208:Acute Disease; D000287:Administration, Topical; D001171:Arthritis, Juvenile / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D002648:Child; D002833:Choroiditis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D004338:Drug Combinations; D004596:Electroretinography; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008775:Methylprednisolone; D000080364:Multifocal Choroiditis; D015864:Panuveitis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D011239:Prednisolone / Q000031:analogs & derivatives / Q000627:therapeutic use; D012160:Retina / Q000503:physiopathology; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014606:Uveitis, Anterior / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D014792:Visual Acuity / Q000502:physiology
chemical_list: D004338:Drug Combinations; D005938:Glucocorticoids; C009935:prednisolone acetate; D011239:Prednisolone; D008775:Methylprednisolone