1. 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

2. 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

3. choroiditis ?
chronic CSC ?
CSC secondary to choroiditis?

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

5. 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)

6. while the patient is worse…
VA 0.16

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

8. 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 times serum value
IgE times serum value

9. 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

10. 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

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

12. 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

13. 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