Serpiginous choroiditis and acute retinal necrosis occurring in the same patient
A 23-year-old male presented with the complaint of decreased vision in the right eye since 3 months. He had been treated elsewhere for right eye choroiditis with intravenous methyl prednisone acetate (IVMP) 1 g/day for 3 days followed by oral steroids and Tab Azathioprine. At presentation, he was taking Tab Prednisone 50 mg/day and Tab Azathioprine 125 mg/day. Best corrected visual acuities (BCVA) were 20/200 and 20/20 in the right and left eyes, respectively. Left eye was essentially normal on examination. Right eye revealed quiet anterior chamber and quiet vitreous cavity with a yellowish area of active choroiditis with geographic borders involving the macula in serpiginous pattern. Fundus fluorescein angiography confirmed the findings. He was diagnosed as a case of active macular serpiginous choroiditis. After obtaining physician's clearance, we prescribed Tab Prednisone 60 mg/day (1 mg/kg body weight), Tab Azathioprine 50 mg thrice a day, Tab Cyclosporine 150 mg twice a day, with antacid and calcium supplements. QuantiFERON-TB Gold test was found to be negative. On regular follow-up visits, the choroiditis lesions were noted to heal over a period of 3 months, and treatment was gradually tapered.\nAfter 3 months, patient complained of redness, pain and blurring of vision in the left eye. At this point of time, he was on Tab Prednisone 7.5 mg/day, Tab Azathioprine 50 mg/day and Tab Cyclosporine 200 mg/day. BCVA were 20/400 and 20/20 partial in the right and left eyes, respectively. Right eye examination revealed a quiet eye with healed lesions of macular serpiginous choroiditis []. Left eye had 2+ anterior chamber cells, severe vitritis, and an area of retinal whitening suggestive of necrotizing retinitis in the inferonasal periphery. A clinical diagnosis of acute retinal necrosis was made. Tab Cyclosporine and Tab Azathioprine were stopped, Tab Prednisone was hiked to 60 mg/day, and intravenous Aciclovir 500 mg thrice a day was started under monitoring. Serum ELISA for Human immunodeficiency virus (HIV) was negative. On regular examinations, vitreous haze decreased markedly and the lesion showed signs of healing []. After 1 week, intravenous Aciclovir was stopped and the patient was prescribed Tab Valaciclovir 1 g thrice a day, and Tab Prednisone to be tapered at 10 mg/week. As on last visit after 2 months, anterior chamber was quiet and retinitis had resolved significantly. The patient is under regular follow-up.