Sequential bilateral Behçet’s neuroretinitis associated with prepapillary vitreous exudate: case report

• Published in: Journal of ophthalmic inflammation and infection Vol. 10; no. 1; p. 33
• Main Authors: Ksiaa, Imen, Ben Aoun, Safa, Zina, Sourour, Nefzi, Dhouha, Khochtali, Sana, Khairallah, Moncef
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 07.12.2020; Springer Nature B.V; SpringerOpen
• Subjects: Behçet uveitis; Brief Report; Case report; Case reports; Enzymes; Infections; Inflammation; Medical imaging; Medicine; Medicine & Public Health; OCT angiography; Ophthalmology; Prepapillary exudate; Retina; Swept source OCT; Ulcers; Prepapillary exudate; OCT angiography; Case report; Swept source OCT; Behçet uveitis
• ISSN: 1869-5760; 1869-5760
• DOI: 10.1186/s12348-020-00226-y

Objective To describe a case of Behçet disease (BD) uveitis manifesting with sequential bilateral neuroretinitis associated with prepapillary inflammatory vitreous exudate (PIVE). Material and methods A single case report documented with multimodal imaging. Results A 37-year-old man developed neuroretinitis with associated PIVE in the left eye. He was diagnosed with ocular toxoplasmosis and treated accordingly based on positive serologic testing and negative work-up for other entities, including BD. The disease course was favorable, but 1 year later a similar neuroretinitis developed in the right eye. Extraocular features of BD became evident only at the time of the second eye involvement, and the patient received corticosteroid and immunosuppressive therapy. Swept source (SS) OCT showed at the acute phase in both eyes a typical “mushroom-shaped” prepapillary hyperreflectivity of the PIVE. SS OCT angiography (OCTA) demonstrated a corresponding prepapillary hypointense area due to shadowing effect, decreasing in size while scanning deeper layers. It also detected peripapillary retinal hypervascularity in both eyes and a sectoral area of flow signal loss in the first involved left eye. Visual acuity improved following the resolution of the PIVE and associated acute inflammatory changes in both eyes. The left eye showed residual optic disc pallor and retinal nerve fiber layer defects. Conclusion Sequential bilateral neuroretinitis associated with PIVE may occur before other clinical features of BD become evident. SS OCT and OCTA can provide useful information for the diagnosis and management of this rare, but typical, ocular manifestation of BD uveitis.