APMPPE is one of the white dot syndromes that occurs in young healthy adults and similarly affects males and females. It is usually bilateral, although may be worse in one eye. APMPPE is generally a self-limited condition that requires no treatment and has a good prognosis.
A 47-year-old female presents with a four day history of fluttering bright spots in the right eye. She denies a viral prodrome or headaches.
A 36-year-old woman presented with progressive vision loss in both eyes following a viral infection. On exam, there were placoid areas of whitening throughout the posterior pole of both eyes. On fluorescein angiography, the lesions on exam demonstrated early blocking defects and late staining.
A 39-year-old woman with a history of multiple sclerosis on ofatumumab (CD20 inhibitor) presented with progressive vision loss, left greater than right, for one week. The patient reported a history of a self-limited upper respiratory infection five weeks prior. An anterior chamber tap was performed and was negative for CMV, VZV, HSV-1 and HSV-2 PCR testing. Additional laboratory testing was notable for negative syphilis total antibody, negative quantiferon-TB gold and a mildly elevated platelet count. MRI/MRA of the Brain WWO Contrast and MRI Orbit WWO contrast demonstrated no evidence of CNS vasculitis or evidence of new or active demyelination. On exam, she demonstrated creamy placoid lesions in the posterior pole and periphery. The peripheral patches were subacute appearing with pigmentary changes and atrophy. She started on prednisone 60 mg daily after infectious testing returned negative and the patient was monitored for recurrence.
Ophthalmic Atlas Images by EyeRounds.org, The University of Iowa are licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
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