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Niloofar Piri, Henry J Kaplan; Occult multifocal choroiditis. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3136.
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To report occult multifocal choroiditis as an underdiagnosed entity.
Retrospective chart review of diagnostic testing in four patients with idiopathic uveitis
Four patients with idiopathic uveitis (3 anterior uveitis, one vitritis) demonstrated multiple hypofluorescent (dark) spots on ICG angiography without clinical evidence of choroiditis on funduscopy or SD-OCT. All had increased serum IgG titers to herpes viruses (HSV1, 2; CMV; EBV; HHV6 and VZV), with two showing markedly elevated IgM titers to HSV 2.Three patients showed very high IgG titers to EBV, HHV6 and VZV. The patient who presented with vitritis, responded to Acyclovir treatment with complete resolution of vitritis; 3 months later she developed acute anterior uveitis with diffuse stellate KPs and raised intraocular pressure. Anterior chamber paracenthesis was performed and PCR was done which was positive for HSV 2 and confirmed the prior diagnosis. She responded clinically to another course of Acyclovir treatment.
In patients with idiopathic uveitis non-responsive to corticosteroid treatment or unexplained decreased vision, occult multifocal choroiditis should be considered.ICG angiography may be essential in detecting occult multifocal choroiditis, and can lead to the investigation of unexpected herpesvirus infection.
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