Three Cases of Erdheim-Chester Disease With Intraocular Manifestations: Imaging and Histopathology Findings of a Rare Entity.
OBJECTIVE
To report intraocular manifestations of Erdheim-Chester Disease (ECD) with multimodal imaging.


METHODS
A retrospective observational case series.


METHODS
This was a multicenter case series of 3 patients with confirmed tissue diagnosis of ECD that showed intraocular manifestations and were imaged at baseline and follow-up visits.


RESULTS
Intraocular manifestations are rarely observed in association with ECD. Intraocular manifestations of ECD seen on multimodal imaging include histiocytic choroidal infiltration causing choroidal lesions, complicated by recurrent serous retinal detachment (SRD). Short-term resolution of SRD was observed with ocular therapies including intravitreal injections of anti-vascular endothelial growth factor or verteporfin photodynamic therapy in combination with systemic chemotherapy therapies and oral corticosteroids; however, recurrences were common. Chorioretinal biopsy confirmed the diagnosis of ECD in 1 case, with the presence of histiocytic infiltration, fibrosis, and characteristic immunohistologic staining. In another case, with a novel ARAF positive mutation, treatment with sorafenib showed regression of the choroidal lesions and resolution of the SRD on multimodal imaging. These lesions were previously resistant to other forms of therapy.


CONCLUSIONS
Rare intraocular manifestations of ECD confirmed on histopathology can be imaged with multimodal imaging. We report 3 cases, including 1 case diagnosed through histology from chorioretinal biopsy and another case associated with a novel ARAF mutation responsive to targeted therapy with sorafenib. The identification of novel somatic mutation associated with ECD enabled treatment with a new-targeted systemic agent. Multimodal imaging in these cases can also be used to monitor response to therapy.
Vitreous Retina Macula Consultants of New York, New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan, Eye, Ear and Throat Hospital, New York, New York; Singapore National Eye Center/Singapore Eye Research Institute, Singapore. Electronic address: annacstan@gmail.com.
Anna C S
ACS
Tan
The Rotterdam Eye Hospital, Rotterdam, Netherlands.
Suzanne
S
Yzer
Retina Center of Hawaii, Honolulu, Hawaii.
Neal
N
Atebara
Memorial Sloan Kettering Cancer Center, New York, New York.
Brian P
BP
Marr
Department of Pathology, Section Ophthalmic Pathology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands.
Robert M
RM
Verdijk
Departments of Internal Medicine & Immunology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands.
Virgil A S H
VASH
Dalm
Vitreous Retina Macula Consultants of New York, New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan, Eye, Ear and Throat Hospital, New York, New York.
K Bailey
KB
Freund
Vitreous Retina Macula Consultants of New York, New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan, Eye, Ear and Throat Hospital, New York, New York.
Lawrence
L
Yannuzzi
The Rotterdam Eye Hospital, Rotterdam, Netherlands.
Tom
T
Missotten
D000328:Adult; D000369:Aged, 80 and over; D001706:Biopsy; D002829:Choroid / Q000000981:diagnostic imaging; D018450:Disease Progression; D031249:Erdheim-Chester Disease / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D035583:Rare Diseases; D012160:Retina / Q000000981:diagnostic imaging*; D012167:Retinal Perforations / Q000175:diagnosis* / Q000209:etiology; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence / Q000379:methods*; D014792:Visual Acuity