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Clinical Cases
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CHORIORETINAL INFLAMMATORY DISEASES - Noninfectious Causes

Serpiginous Choroiditis

Serpiginous Choroiditis - Start  
Serpiginous Choroiditis - End  

Serpiginous choroiditis is a bilateral inflammatory disease of unknown cause that represents a pathologic affliction of the retinal pigment epithelium, choriocapillaris, and inner choroid. There is a disruption of the overlying neurosensory retina, marked by periods of activity with intervening intervals of quiescence.

It typically occurs in young to middle-aged white people.

Acute lesions have a gray-white or yellow appearance that begin around the optic nerve or the posterior pole and advance centrifugally by recurrences, to the midperiphery, in an irregular serpentine fashion, leading to scarring and choroidal atrophy. They may result in choroidal neovascular membrane in as many 25% of patients.

Given the unpredictability of the disease progression, the fovea is never truly safe from eventual involvement.

Diferential Diagnosis

Acute posterior multifocal placoid pigment epitheliopathy

Infectious disorders

Presumed ocular histoplasmosis syndrome

  • Syphilis
  • Toxoplasmosis
  • Tuberculosis

Inflammatory diseases

  • Multifocal choroiditis
  • Posterior scleritis
  • Sarcoidosis

Degenerative/dystrophic disorders

  • Best disease
  • Central areolar choroidal dystrophy
  • Fundus flavimaculatus
  • Sorsby´s pseudo-inflammatory dystrophy

Infiltrative diseases of the choroid

  • Choroidal osteoma
  • Metastatic tumor
  • Non-Hodgkin’s lymphoma (reticulum cell sarcoma)

Choroidal neovascularization

  • Age-related macular degeneration
  • Angioid streaks Drusen of optic nerve head
  • Idiopathic choroidal neovascularization
  • Pathologic myopia
  • Peripapillary subretinal neovascularization
 
Clinical Cases 679 0