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Ophthalmic Images
April 13, 2017

Serpiginous Choroiditis

Author Affiliations
  • 1University of New England College of Osteopathic Medicine, Biddeford, Maine
  • 2Massachusetts Eye Research & Surgery Institute, Waltham
  • 3Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston
JAMA Ophthalmol. 2017;135(4):e165495. doi:10.1001/jamaophthalmol.2016.5495

A woman in her late 40s presented with bilateral, progressive, and blurry vision for 1 month. Her visual acuity was 20/30 OD and her finger counting was at 1 m OS. Fundus imaging and a fluorescein angiogram were obtained bilaterally (Figure). The macula was involved in the left eye but spared in the right. Systemic and infectious workup results, including an interferon-gamma release assay and herpesvirus titer, were negative. Her clinical findings, along with a negative serology result, led to her receiving a diagnosis of serpiginous choroiditis. She was treated with prednisone at 50 mg per day for her acute episode and chlorambucil at 6 mg weekly to achieve a steroid-sparing remission, as described in a recent case series.1,2 At a follow-up 6 months later, the lesions on the fluorescein angiogram were stable bilaterally, with improvement shown in her visual acuity. Her chlorambucil dosage was titrated for a target weekly white blood cell count and continued for 9 months without adverse effects.

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