HCUVA Murcia for Schistosome Choroiditis Juan Carlos Pastor Bernier Central Serous Chorioretinopathy mistaken for Schistosome Choroiditis Juan Carlos Pastor Bernier Mercedes Hernández Martínez José María Marín Sánchez HCUVA Murcia

ophthalmoscopic diagnosis focal granulomatous choroiditis RE case report VA 0.3 VA 0.8 50-year-old man, referred to uveitis unit blurred vision RE and headache, for 3 weeks systemic prednisone, for 1 week farmer from Ecuador no history of interest VA RE 0.3 / LE 0.8 IOP 14 / 12 no anterior uveitis no vitritis ophthalmoscopic diagnosis focal granulomatous choroiditis RE retinal folds focal chorioretinitis inferior exudative RD pigmentary changes

choroiditis ? chronic CSC ? CSC secondary to choroiditis?

systemic prednisone 1 mg/kg/d atypical VKH ??? extensive uveitis study protocol !! maintain treatment systemic prednisone 1 mg/kg/d exudative RD

associated systemic disease is discarded 2 weeks later… associated systemic disease is discarded IgE serum Serology TOXP + EBV + HSV 1/2 + Hepatitis B V + Schistosome choroiditis?? Schistosoma IgG positivo 2.06 (ELISA)

while the patient is worse… VA 0.16

while the patient is worse… what can we do? VA 0.5

discontinue corticosteroids diagnostic and therapeutic PPV RE SRF study 1 General culture and PCR Herpes SRF: negative Flow cytomertry SRF: negative Cytology SRF: cells RPE with lipofuscin Immunochemistry SRF H-Eosin IgG 4 times serum value IgE 3 times serum value

untreated patient 2 weeks after PPV RE 111 applied retina RE VA 0.1 applied retina RE exudative RD LE active disease OU 1111 111

what do we do? empirical treatment with albendazole 2 weeks after PPV RE what do we do? VA 0.5 empirical treatment with albendazole 1111 exudative RD

before albendazole VA 0.1 VA 0.5 VA 0.2 + 2 weeks albendazole VA 0.7

8 months without recurrence we decided to administer praziquantel (anti-schistosome specific drug) VA 0.8 + 4 weeks praziquantel VA 1 8 months without recurrence

CONCLUSIONS This case confirms that patients with chronic CSC may be misdiagnosed with a posterior uveitis and worsen with the use of systemic corticosteroids. We don´t know how to interpret the large increase of IgE, both in serum and subretinal fluid. The rapid response to treatment with albendazole and praziquantel could be explained by a decreased plasma cortisol (implicated in CSC) although to our knowledge there is no reference in the literature to support this theory. J Ophthalmic Vis Res 2011; 6 (4): 334-7 Klin Monbl Augenheilkd 2002; 219:264-7 Br J Ophthalmol 1985; 69:300-2