Presumed acute posterior multifocal placoid pigmentary epitheliopathy associated with Bartonella infection

ABSTRACT To report a unique case of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) in a patient with positive serology for Bartonella, presenting with ocular signs and symptoms not attributable to other diseases. A 27-year-old woman presented with decreased visual acuity in both eyes. Multimodal fundus image analysis was performed. A color fundus photograph of both eyes revealed peripapillary and macular yellow-white placoid lesions. The fundus autofluorescence of both eyes demonstrated hypo- and hyperautofluorescence of the macular lesions. Fluorescein angiography showed early-stage hypofluorescence and late staining of placoid lesions in both eyes. Spectral domain optical coherence tomography (SD-OCT) of both eyes revealed irregular elevations in the retinal pigment epithelium with the disruption of the ellipsoid zone on the topography of macular lesions. At 3 months after the treatment initiation for Bartonella infection, the placoid lesions became atrophic and hyperpigmented, and SD-OCT revealed loss of both the outer retinal layers and retinal pigment epithelium on the topography of macular lesions in both eyes.

摘要 本文报告1例巴尔通体（Bartonella）血清学检测阳性的急性后部多灶性鳞状色素上皮病变（acute posterior multifocal placoid pigment epitheliopathy，APMPPE）病例，该患者出现无法归因于其他疾病的眼部体征与症状。患者为27岁女性，因双眼视力下降就诊。本次研究对其实施了多模态眼底影像分析：双眼彩色眼底照相可见视盘旁及黄斑区黄白色鳞状样病灶；双眼眼底自发荧光显示黄斑病灶呈现低自发荧光与高自发荧光混杂表现；荧光素眼底血管造影显示双眼鳞状样病灶早期呈低荧光、晚期染色；双眼光谱域光学相干断层扫描（SD-OCT）可见黄斑病灶区域视网膜色素上皮不规则隆起，且椭圆体带出现中断。经针对巴尔通体感染的治疗3个月后，原鳞状样病灶出现萎缩并伴色素沉着，SD-OCT显示双眼黄斑病灶区域视网膜外层及视网膜色素上皮均出现缺失。