Akutna posteriorna multifokalna plakoidna pigmentna epiteliopatija (APMPPE) – moguća klinička slika okularne borelioze prikaz slučaja = Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) – a possible clinical picture of ocular borreliosis : case report - Benašić, Tvrtka; Vinković, Maja, liječnica; Kopić, Andrijana; Vukojević, Nenad; Mandić, Krešimir, liječnik; Biuk, Dubravka (2019)
Cilj: Prikazati slučaj pacijenta s akutnom posteriornom multifokalnom plakoidnom pigmentnom epiteliopatijom (APMPPE) u sklopu infekcije borelijom Lyme. Prikaz slučaja: Šesnaestogodišnjeg pacijenta uputio je pedijatar zbog naglog pada vidne oštrine na desnom oku. Vidna oštrina kod dolaska bila je 0,01 po Snellenu. Žalio se i na zatiljnu glavobolju unazad nekoliko dana i naveo ubod nepoznatog kukca s okolnim osipom na koži. Na oba oka na fundusu su se utvrdili znakovi korioretinitisa. Učinjena je optička koherentna tomografija (OCT, engl. optical coherence tomography), OCT-angiografija (OCT-A), vidno polje (VP), fluoresceinska angiografija (FA), angiografija indocijanin zelenilom (ICGA, engl. indocyanine green angiography), kompletna laboratorijska, serološka i imunološka obrada, rendgen srca i pluća, magnetska rezonancija (MR) mozga, pregled i konzultacija infektologa i neuropedijatra. Postavljena je dijagnoza APMPPE-a i uvedena peroralna terapija metilprednizolonom 0,5 mg/kg tjelesne težine i doksiciklinom 2 x 100 mg dnevno. Serodijagnostika je pokazala povišene vrijednosti IgM i IgG na Borreliu spp metodom imunoenzimske analize (ELISA, engl. Enzyme Linked Immuno Sorbent Assay), što je bilo potvrđeno western blot analizom. Terapija je dovela do brzog poboljšanja kliničke slike i vidne oštrine na 0,75. Zaključci: Želimo naglasiti da je u slučaju APMPPE-a potrebno napraviti kompletnu obradu kako bi se isključile konkomitantne infekcije, a potrebno je posumnjati i na okularnu boreliozu, osobito u slučaju ugriza krpelja ili nepoznatog kukca, čak i kad se pacijenti ne sjećaju ugriza. Ovakav pristup omogućava promptno liječenje APMPPE-a i borelioze kako bi se smanjile okularne ili/i sistemske komplikacije.
Aim: To present a case report of a patient with acute posterior multifocal placoid pigment epitheliopathy (APMPPE) with borreliosis. Case report: A 16-year-old male patient presented with a heavy visual acuity loss on the right eye (BCVA 0.01 on Snellen chart) and occipital headache that lasted a few days. He recalled a bite of an unknown bug and a skin rash around it. Acute chorioretinitis was present bilaterally. Optical coherence tomography (OCT), OCT-angiography (OCTA), visual field (VF), fluorescein angiography (FA), indocyanine green angiography (ICGA), complete laboratory, chest x ray, brain magnetic resonance imaging (MRI). Infectologist and neuropediatric examination and consultation were made. The diagnosis of APMPPE was established and the oral therapy was induced (methylprednisolone 0.5 mg/ kg/day and doxycycline 2x100 mg/day). Elevated titres of IgM and IgG antibodies to Borrelia spp. were found on Enzyme Linked Immuno Sorbent Assay (ELISA) and confirmed by western-blot. A quick restoration of the clinical picture and visual acuity up to 0.75 were noticed after the administration of the therapy. Conclusions: It is important to emphasize that in the case of APMPPE it is necessary to exclude concomitant infections, especially ocular borreliosis, particularly in the case of a tick or any bug bite, even in cases when the patients do not remember the bug bite. In those circumstances the prompt therapy of APMPPE and borreliosis assures proper treatment, which diminishes ocular or systemic complications.
Bibliografija: 26 jed.
Sažetak ; Abstract.
Keywords: Borrelia -- Korioretinitis -- Lymeova bolest