Clinical case: Serpiginous-like choroiditis with macular involvement and good response after treatment with adalimumab.

Clinical case of a 42-year-old woman who consulted for decreased vision in the left eye over two months, associated with multifocal choroiditis. Different diagnostic tests were performed to rule out infectious pathologies, as well as a diagnostic vitrectomy test, which was negative. QuantiFERON® was found to be positive and a diagnosis of serpeginous-like choroiditis (SLC) was made. Anti-tuberculosis treatment was started with worsening of vision and multifocal choroiditis. Once conventional immunotherapy and biological treatment were added, the patient presented a significant improvement in vision. To conclude, in cases of CSL, it is not only necessary to treat the infection but also the inflammatory component either with steroids or conventional immunotherapy or immunosuppression with biologics, thus reducing the number of reactivations and improving the visual prognosis.

Caso clínico: coroiditis serpiginosa-like con afectación macular y buena evolución tras tratamiento con adalimumab / Clinical case: Serpiginous-like choroiditis with macular involvement and good response after treatment with adalimumab

Se presenta el caso clínico de una mujer de 42 años, que consultó por disminución de visión del ojo izquierdo de 2 meses evolución, asociada a coroiditis multifocal. Se realizaron diferentes pruebas diagnósticas para descartar enfermedad infecciosa, al igual que se realizó una vitrectomía diagnóstica, que resultó negativa. Se encontró QuantiFERON® positivo y se realizó el diagnóstico de coroiditis serpiginosa-like (CS-L). Se inició tratamiento antituberculoso con empeoramiento de la visión y de la coroiditis multifocal. Una vez que se agregaron inmunoterapia convencional y tratamiento biológico, la paciente presentó mejoría significativa de la visión. Para concluir, en casos de CS-L no solo es necesario el tratamiento de la infección, sino también del componente inflamatorio, sea con inmunoterapia convencional o inmunosupresión con biológicos, y así disminuir el número de reactivaciones mejorando el pronóstico visual (AU)

Clinical case of a 42-year-old woman who consulted for decreased vision in the left eye over 2months, associated with multifocal choroiditis. Different diagnostic tests were performed to rule out infectious pathologies, as well as a diagnostic vitrectomy test, which was negative. QuantiFERON® was found to be positive and a diagnosis of serpiginous-like choroiditis (SLC) was made. Anti-tuberculosis treatment was started with worsening of vision and multifocal choroiditis. Once conventional immunotherapy and biological treatment were added, the patient presented a significant improvement in vision. To conclude, in cases of SLC, it is not only necessary to treat the infection but also the inflammatory component either with steroids or conventional immunotherapy or immunosuppression with biologics, thus reducing the number of reactivations and improving the visual prognosis (AU)

OCT-angiography for diagnosis and response to treatment of subretinal neovascularization secondary to idiopathic macular telangiectasia type 2.

Idiopathic macular telangiectasia type 2 (MacTel 2) is a slow and progressive bilateral condition that affects middle-aged and elderly individuals. Vision loss is generally mild and occurs over the course of many years. The development of sub-retinal neovascularisation (SRNV) can occur late in the disease process, and lead to more dramatic vision loss. A report is presented of 2 cases of MacTel 2 in which optical coherence tomography angiography (OCTA) was essential for the diagnosis of secondary SRNV. The commercially available OCTA Cirrus AngioPlex 5000 platform (Zeiss, Jena, Germany) was used. Subretinal neovascularization was detectable in both cases in OCTA at the level of the deep capillary plexus and the avascular layer. OCTA also allowed us to monitor disease progression and monitor response to anti-VEGF therapy.

Angiografía-OCT para diagnóstico y respuesta al tratamiento de la neovascularización subretiniana secundaria a telangiectasia macular idiopática tipo 2 / OCT-angiography for diagnosis and response to treatment of subretinal neovascularization secondary to idiopathic macular telangiectasia type 2

La telangiectasia macular idiopática tipo 2 (MacTel 2) es una afección bilateral, lenta y progresiva que afecta a individuos de mediana edad y ancianos. La pérdida de visión es generalmente leve y ocurre en el transcurso de muchos años. El desarrollo de neovascularización subretiniana (NVSR) puede ocurrir tarde en el proceso de la enfermedad y conducir a una pérdida de visión más dramática. Presentamos 2casos de MacTel 2 donde la angiografía por tomografía de coherencia óptica (OCTA) fue fundamental para el diagnóstico de NVSR secundaria. Se utilizó la plataforma comercialmente disponible OCTA Cirrus AngioPlex 5000 (Zeiss, Jena, Alemania). La NVSR fue detectable en ambos casos con OCTA a nivel del plexo capilar profundo y en la capa avascular. La OCTA también nos permitió controlar la progresión de la enfermedad y monitorizar la respuesta a la terapia anti-VEGF (AU)

Idiopathic macular telangiectasia type 2 (MacTel 2) is a slow and progressive bilateral condition that affects middle-aged and elderly individuals. Vision loss is generally mild and occurs over the course of many years. The development of sub-retinal neovascularisation (SRNV) can occur late in the disease process, and lead to more dramatic vision loss. A report is presented of 2cases of MacTel 2 in which optical coherence tomography angiography (OCTA) was essential for the diagnosis of secondary SRNV. The commercially available OCTA Cirrus AngioPlex 5000 platform (Zeiss, Jena, Germany) was used. Subretinal neovascularization was detectable in both cases in OCTA at the level of the deep capillary plexus and the avascular layer. OCTA also allowed us to monitor disease progression and monitor response to anti-VEGF therapy (AU)

OCT-angiography for diagnosis and response to treatment of subretinal neovascularization secondary to idiopathic macular telangiectasia type 2. / Angiografía-OCT para diagnóstico y respuesta al tratamiento de la neovascularización subretiniana secundaria a telangiectasia macular idiopática tipo 2.

Idiopathic macular telangiectasia type 2 (MacTel 2) is a slow and progressive bilateral condition that affects middle-aged and elderly individuals. Vision loss is generally mild and occurs over the course of many years. The development of sub-retinal neovascularisation (SRNV) can occur late in the disease process, and lead to more dramatic vision loss. A report is presented of 2cases of MacTel 2 in which optical coherence tomography angiography (OCTA) was essential for the diagnosis of secondary SRNV. The commercially available OCTA Cirrus AngioPlex 5000 platform (Zeiss, Jena, Germany) was used. Subretinal neovascularization was detectable in both cases in OCTA at the level of the deep capillary plexus and the avascular layer. OCTA also allowed us to monitor disease progression and monitor response to anti-VEGF therapy.

Manifestación clínica ocular inusual de la leptospirosis / Unusual ocular clinical manifestation of leptospirosis

CASO CLÍNICO: Se presenta un caso clínico poco frecuente de una mujer de 15 años afectada por múltiples desprendimientos serosos bilaterales de retina y epitelio pigmentario. Con el diagnóstico clínico y de laboratorio (inmunofluorescencia indirecta [IFI] IgG 1/160 e IgM 1/160) de leptospirosis se realizó un examen oftalmológico completo, angiofluoresceingrafía, autofluorescencia y tomografía de coherencia óptica y se siguió al paciente durante 2 años. Discusión: Los desprendimientos serosos bilaterales y múltiples de la retina y del epitelio pigmentario pueden ser una complicación de la leptospirosis sistémica, zoonosis causada por Leptospira. Sin una historia médica detallada, puede permanecer sin ser diagnosticada, principalmente porque puede imitar otras enfermedades más frecuentes. Puede ser prudente preguntar a los pacientes sobre contacto con mascotas

CLINICAL CASE: An uncommon case is presented of a 15 year-old girl with bilateral, multiple serous detachments of retina and retinal pigment epithelium. With clinical and laboratory (IgG 1/160 and IgM 1/160, using an indirect immunofluorescence assay) diagnoses of leptospirosis, a complete ophthalmic examination, fluorescein angiography, autofluorescence and optical coherence tomography were performed, and the patient was followed for two years. DISCUSSION: Bilateral, multiple serous detachments of retina and retinal pigment epithelium can be a complication of systemic leptospirosis, a zoonotic disease caused by Leptospira. Without a detailed medical history it may be underdiagnosed, mainly because it can mimic other more common diseases. It may be prudent to ask patients regarding contact with pets

Tubérculo coroideo asintomático en un paciente con enfermedad de Crohn en tratamiento con adalimumab / Asymptomatic choroidal tubercle in a patient with Crohn's disease on adalimumab treatment

Introducción: Adalimumab, un antifactor de necrosis tumoral que se utiliza en la enfermedad de Crohn activa (EC), se asocia con un mayor riesgo de tuberculosis. Caso clínico: Se describe el caso de un varón de 48 años con EC activa en tratamiento con adalimumab. Después de 3 meses desarrolló una tuberculosis pulmonar miliar, y en un estudio oftalmológico se encontró un tubérculo coroideo no reactivo solitario temporal superior al disco óptico. La angiofluoresceingrafía mostró hiperfluorescencia tardía. Con la tomografía de coherencia óptica se observó una masa plana sin desprendimiento seroso de retina. El tubérculo coroideo regresó lentamente con la terapia antituberculosa. Discusión: En pacientes con EC y en tratamiento con adalimumab, un tubérculo coroideo puede presentarse sin sintomatología vítreo-retiniana (AU)

Introduction: Adalimumab, an anti-tumour necrosis factor alpha therapy for active Crohn's disease (CD), is associated with increased risks of tuberculosis infection. Case report: The case is presented of a 48 year-old male with active CD on treatment with adalimumab. After three months, he developed a miliary pulmonary tuberculosis infection, with a solitary non-reactive choroidal tubercle temporal-superior to the optic disc being found in an ophthalmological study. Fluorescein angiography showed late hyperfluorescence in a staining pattern. Optic coherence tomography showed a flat mass without serous retinal detachment. The choroidal tubercle slowly regressed with antituberculosis therapy. Discussion: Choroidal tubercles with no vitreo-retinal symptomatology can be present in patients with CD and on treatment with adalimumab (AU)

Unusual ocular clinical manifestation of leptospirosis. / Manifestación clínica ocular inusual de la leptospirosis.

CLINICAL CASE: An uncommon case is presented of a 15 year-old girl with bilateral, multiple serous detachments of retina and retinal pigment epithelium. With clinical and laboratory (IgG 1/160 and IgM 1/160, using an indirect immunofluorescence assay) diagnoses of leptospirosis, a complete ophthalmic examination, fluorescein angiography, autofluorescence and optical coherence tomography were performed, and the patient was followed for two years. DISCUSSION: Bilateral, multiple serous detachments of retina and retinal pigment epithelium can be a complication of systemic leptospirosis, a zoonotic disease caused by Leptospira. Without a detailed medical history it may be underdiagnosed, mainly because it can mimic other more common diseases. It may be prudent to ask patients regarding contact with pets.

Asymptomatic choroidal tubercle in a patient with Crohn's disease on adalimumab treatment. / Tubérculo coroideo asintomático en un paciente con enfermedad de Crohn en tratamiento con adalimumab.

INTRODUCTION: Adalimumab, an anti-tumour necrosis factor alpha therapy for active Crohn's disease (CD), is associated with increased risks of tuberculosis infection. CASE REPORT: The case is presented of a 48 year-old male with active CD on treatment with adalimumab. After three months, he developed a miliary pulmonary tuberculosis infection, with a solitary non-reactive choroidal tubercle temporal-superior to the optic disc being found in an ophthalmological study. Fluorescein angiography showed late hyperfluorescence in a staining pattern. Optic coherence tomography showed a flat mass without serous retinal detachment. The choroidal tubercle slowly regressed with antituberculosis therapy. DISCUSSION: Choroidal tubercles with no vitreo-retinal symptomatology can be present in patients with CD and on treatment with adalimumab.