Fulminant chorioretinitis and papillitis secondary to coxsackievirus B presenting as acute posterior multifocal placoid pigment epitheliopathy with positive response to intravenous immunoglobulin.

PURPOSE: To describe a case of fulminant bilateral papillitis and chorioretinitis in the setting of positive coxsackievirus B titers, which convalesced months after the patient's presentation. The patient presented with an acute posterior multifocal placoid pigment epitheliopathy-like clinical picture and her visual acuity and visual field improved moderately after initiation of treatment with intravenous immunoglobulin. METHODS: Case report of a white female with bilateral blurred vision is presented in this study. RESULTS: A previously healthy 59-year-old white woman presented with a 3-day history of bilateral blurred vision. Initial visual acuity was hand motion in the right eye and count fingers in the left eye. Extensive workup and imaging was done and she was empirically started on intravenous antibiotics followed 24 hours later by intravenous steroids. The patient was found to have high titers of coxsackievirus B and sustained modest visual acuity and perimetry improvement in one eye after intravenous immunoglobulin infusion. CONCLUSION: A case of fulminant bilateral chorioretinitis and papillitis that resulted in bilateral vision loss despite high-dose steroids within 24 hours of initial loss in vision is presented in this study. The patient was found to have high titers of coxsackievirus B3, B4,B5 after presentation and her condition improved after treatment with intravenous immunoglobulin, suggesting a plausible immune component.