OVERLAPPING FEATURES OF UNILATERAL VOGT-KOYANAGI-HARADA AND AMPPPE

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OVERLAPPING FEATURES OF UNILATERAL VOGT-KOYANAGI-HARADA AND AMPPPE OVERLAPPING FEATURES OF UNILATERAL VOGT-KOYANAGI-HARADA AND AMPPPE . OPEN CASE. Martínez-Martín J., MD; Díez-Villalba R., MD; Baztán-Lacasa J., MD; García-Bermejo I., MD; Jordano-Luna L., MD; Gili-Manzanaro P., MD. 48 YEARS-OLD WOMAN WITH IDIOPATHIC CD4-LYMPHOPENIA HERPETIC KERATOUVEITIS ON RIGHT EYE DIAGNOSED. AFTER 22 DAYS OF TOPICAL CORTICOSTEROIDS, CYCLOPENTOLATE AND ORAL VALGANCICLOVIR. ACUTE VISION LOSS OF RIGHT EYE. HERPETIC COROIDITIS ON RIGHT EYE DIAGNOSED. SENT TO OUR SERVICE.

Initial examination. Right eye: Left eye: Normal VA: CF PH 0.05 BMC: PKs, Anterior Chamber cells 2+, Anterior Vitreous cells 1+. FO: Posterior Vitreous cells 1+, NSD temporal inferior with macular envolvement and white subretinal lesions. Macular OCT: Harada-like NSD AFG: Deep hypofluorescent images in early times and late-hyperfluorescent dots with fluorescent SRL. ECO: Normal.

Follow-up (5 months). We decided to treat as Progressive Outer Retinal Necrosis syndrome. Day +3 Starting treatment with intravenous methylprednisolone. Positive serology IgG toxo, IgG, IgG EBNA e IgM EBV, IgG HSV 1. Negative Herpes PCR in aqueous humour. Hypoimmunoglobulinemia A and 56 CD4. No improvement. We reconsider as Masquerade syndrome. No findings in bodyTC, brain nor orbital MRI. No findings in Blood and LCR Immunophenotype and negative HTLV1 and HTLV2 serology Lumbar puncture: Elevated levels of Protein and positive EBV PCR in CRF.

Resolution and Conclusions. After 11 days, improvement begins and in the last examination: Left Eye: normal Day +35 RETINA: Macula with EPR alteration, without NSD nor subretinal lesions. Hyperemic Optic Disc and peripapillary edema. VA: 0.5 PH 0.8 BMC: Anterior Chamber or vitreous cells–. Pigmented PKs. CLINICAL FINDINGS AND SPONTANEUS RESOLUTION MAKES US THINK IN A RARE UNILATERAL UVEITIS WITH OVERLAPPED FEATURES OF VOGT-KOYANAGI-HARADA DISEASE AND APMPPE. A case of unilateral and spontaneously resolving posterior uveitis with overlapping features of V-K-H disease and APMPPE. Li B et al. (2006). http://www.ncbi.nlm.nih.gov/pubmed/27652046