May 18, 2021
A 25 year old healthy woman noted the onset of vision loss right eye greater than left over the past week. Past ocular history is unremarkable. Although in good general health, she was diagnosed with Hand, Foot, and Mouth disease (Coxsackie virus infection) one month ago. It resolved on its own.
On examination, VA was OD: 20/80 and OS: 20/25. IOP was normal OU. The SLE was normal. DFE and testing is shown below:
The patient was noted to have posterior yellow lesions OD > OS at the level of the RPE. Although infectious causes should be ruled out, these findings are typically autoimmune in nature. The disease is called Acute Multifocal Posterior Placoid Pigment Epitheliopathy (AMPPPE). It is typically seen several weeks after a significant viral or bacterial infection. It is thought to be an autoimmune swelling of the RPE in response to the infection. The course is fairly typical. The deep retinal yellowing usually develops 2-3 weeks after the infection. The placoid lesions expand for a week or two then slowly fade. They retinal appearance afterwords can be normal or there can be some pigment deposition in the areas of the placoid lesions. Visual recovery depends on the amount of RPE disturbance. In most cases it is minimal and vision returns to normal or near normal after several weeks. In our patient’s case, vision returned to 20/20 OU one month after presentation (see photos below):