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the multifocal pattern of the lesions and the angiographic features led to the diagnosis of ampiginous choroiditis .
ampiginous choroiditis is a primary inflammatory choriocapillaropathy with characteristics of both acute posterior multifocal placoid pigment epitheliopathy and serpiginous choroiditis .
this case report is about a 70-year - old caucasian woman who is in good general health although she has medically controlled arterial hypertension and is overweight .
the patient has a 3-dpt hyperopic refraction and there are no important past general or ophthalmologic antecedents in the patient 's history .
the patient developed progressive painful visual blurring in the right eye during an episode of severe sinusitis .
consultation with her local ophthalmologist showed anterior chamber inflammation , macular subretinal fluid with cystoid macular oedema ( fig . 1 ) and scattered whitish lesions in the fundus of the right eye .
anterior chamber inflammation disappeared after treatment with topical steroids , after which the patient was referred to us because of manifestation of new lesions and evolution of the scattered chorioretinal lesions towards atrophy .
consultation at our hospital showed a best - corrected visual acuity of 20/40 for the right and 20/20 for the left eye . slit lamp biomicroscopy showed bilateral nuclear sclerosis but no endothelial precipitates or posterior synechiae .
eye pressure was 12 and 14 mm hg in the right and left eye , respectively .
fundus examination of the right eye showed a peripapillary lesion with pseudopodial extensions and multiple yellow - greyish irregularly bordered lesions ( fig .
fluorescein angiography demonstrated these lesions to be early hypofluorescent with late hyperfluorescent staining of the borders ( fig .
indocyanine green ( icg ) angiography demonstrated these lesions to be early and late hypofluorescent ( fig . 2c ) .
blue light autofluorescence showed these lesions to be hypoautofluorescent with some being mildly granular hyperautofluorescent ( fig .
workup at her local ophthalmologist and with us showed that antinuclear factor , rheumatoid factor , angiotensin - converting enzyme , anti - proteinase 3 and anti - myeloperoxidase , calcemia and syphilis serology were all normal .
there were no systemic signs or symptoms that were suggestive for a diagnosis of sarcoidosis . the multifocal pattern and the angiographic features led us to the diagnosis of ampiginous choroiditis . an intravitreal injection with triamcinolone acetonide was given as a treatment for the macular oedema with resolution of the macular oedema as a consequence ( fig .
we started immunomodulatory treatment with azathioprine 2  50 mg / day to prevent recurrence of inflammation .
after 4 months , we decided to stop therapy with azathioprine since it was not well tolerated by the patient . at the time of writing this case report
, the patient has been followed for more than 1 year . during this period ,
visual acuity has remained stable and no appearance of new lesions or enlargement of the known lesions has occurred .
we present a case report of unilateral uveitis in a healthy 70-year - old woman .
consultation with her local ophthalmologist showed scattered retinal lesions reminiscent of acute posterior multifocal placoid pigment epitheliopathy ( apmppe ) .
these lesions , however , evolved to outer retinal atrophy with angiographic characteristics reminiscent of serpiginous choroiditis .
the combination of characteristics of both apmppe and serpiginous choroiditis led to the diagnosis of ampiginous choroiditis .
the clinical profile of 16 patients with ampiginous choroiditis showed a male preponderance ( 7:3 ) , a median age of 34 years , 81% bilateral involvement and 35% suffered from recurrences .
inflammation at the level of the choriocapillaris leads to areas of choriocapillaris non- or hypoperfusion with ischaemic consequences both at the level of the choroid and at the level of the outer retina .
rarely , an intermediary form between these two diseases , i.e. ampiginous choroiditis , can be seen , but the reason why some patients develop a blend of both diseases is unknown .
it has been proposed that the behaviour of each type of primary inflammatory choriocapillaropathy has to do with the level and severity of vascular damage to the choriocapillaris .
an argument used in favour of this proposition is the fact that in a large series of serpiginous choroiditis , some lesions had initial features of apmppe but showed progression towards serpiginous choroiditis during follow - up .
the aetiology of serpiginous choroiditis is unclear , with degenerative , autoimmune and/or infectious processes considered .
the aetiology of ampiginous choroiditis , which is considered by some to be a subclass of serpiginous choroiditis , is likewise unclear , with some speculating it to be an ocular manifestation of a larger systemic autoimmune condition .
a case of ampiginous choroiditis following a human papillomavirus vaccine was reported , although a causal relationship is not sure .
an ampiginous - like case report showed positive serology in blood and polymerase chain reaction ( pcr ) in aqueous humour for toxoplasma gondii infection .
that patient also had a tuberculin skin test with 15 mm of induration , but negative aqueous humour pcr for mycobacterium tuberculosis .
our patients workup could not identify an underlying cause for this disease , making the origin of this disease unclear . since our patient developed symptoms during an episode of sinusitis , it is tempting to suspect an infectious trigger as a cause .
an important differential diagnostic of ampiginous choroiditis is multifocal serpiginoid choroiditis caused by mycobacterium tuberculosis , treponema pallidum or a herpesvirus .
mycobacterium tuberculosis infection is unlikely since there was no history of previous exposure to tuberculosis and since a tuberculin skin test and chest radiography were both negative .
multifocal lesions , unilaterality and considerable vitreous or anterior chamber inflammation , as in our patient , point towards a diagnosis of tuberculosis multifocal serpiginoid choroiditis instead of a serpiginous choroiditis .
peripapillary involvement from the early phases of the disease , as in our patient , is , however , not typical for a tuberculosis multifocal serpiginoid choroiditis .
we did not perform an anterior chamber tap to do a pcr for mycobacterium tuberculosis or herpesviruses since the patient did not consult us during active inflammation , making a positive pcr result more unlikely .
two other important differential diagnoses are sarcoidosis and granulomatosis with polyangiitis , formerly known as wegener 's granulomatosis .
workup with serum angiotensin - converting enzyme , serum calcium and a chest radiograph also showed no arguments for sarcoidosis .
granulomatosis with polyangiitis is unlikely since the patient did not have systemic manifestations suggestive of this disease and since anti - proteinase 3 and anti - myeloperoxidase testing were normal .
we started immunomodulatory therapy with azathioprine to prevent recurrences , but after 4 months , this medication was stopped since the patient did not tolerate it well .
after consulting the patient , we decided not to start another immunomodulatory agent because there are indications that only one third of patients suffer relapses . after having followed up this patient for more than 1 year , we have not seen an evolution in number or size of retinal lesions .
the absence of diffuse choroidal hyperfluorescence with icg angiography at the edges of the lesions indicates no progression of the lesions .
since some of these lesions still have a hyperautofluorescent aspect , we do suspect some smouldering residual activity in these lesions .
we plan to follow up our patient closely and in the event of any development of activity of an ampiginous lesion towards the macula , we will start systemic therapy with corticosteroids and immunomodulatory therapy .
the health of the patient was our first consideration and we have acted in the patient 's best interest when providing medical care .
there are no financial or nonfinancial interests / relationships that may be interpreted to have influenced the manuscript .
purposepresentation of a case report of a unilateral ampiginous choroiditis.methodsthis is an observational case report.resultsa 70-year - old woman was referred to us with unilateral scattered chorioretinal lesions . 
 the multifocal pattern of the lesions and the angiographic features led to the diagnosis of ampiginous choroiditis.conclusionampiginous choroiditis is a primary inflammatory choriocapillaropathy with characteristics of both acute posterior multifocal placoid pigment epitheliopathy and serpiginous choroiditis .