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  • Coxsackievirus may be tied to acute posterior multifocal placoid pigment epitheliopathy

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    Review of: Long-term multimodal imaging in acute posterior multifocal placoid pigment epitheliopathy and association with coxsackievirus exposure

    Li A, Palejwala N, Shantha J, et al. PLOS One, August 2020

    This was a retrospective, single-center case series of 7 patients diagnosed with acute posterior multifocal placoid pigment epitheliopathy (APMPPE).

    Study design

    Researchers recorded clinical characteristics and analyzed multimodal imaging findings, including spectral-domain OCT, fundus photography and fluorescein angiography each patient. Coxsackievirus B (CVB) titers were also noted.

    Outcomes

    Coxsackievirus B titers were elevated to 1:80 or greater in 6 patients. Notably, the increase in convalescent CVB antibody titers in 2 patients was 4-fold or greater compared with antibody titers during the acute phase of disease, suggesting recent or active coxsackievirus infection. The patients were treated with immunosuppression: all received oral corticosteroids, 1 patient received IV corticosteroid and 5 received additional steroid-sparing agents. Multimodal imaging revealed that choroidal inflammation preceded outer retinal damage and photoreceptor loss.

    Limitations

    While the study suggests a significant association between CVB infection and the clinical diagnosis of APMPPE, the implications are limited by the small sample size. In addition, the authors were unable to rule out other potential viral triggers that may not have been assessed. There is a risk for false-positive results with the use of PCR testing in these patients. Nevertheless, the role of CVB in APMPPE warrants further investigation.

    Clinical significance

    Patients presenting with posterior uveitis that resembles AMPPE should be assessed for CVB titers. Choroidal imaging modalities, including enhanced-depth imaging OCT and indocyanine green angiography, should be utilized to assess for choroidal inflammation, which may indicate possible outer retinal damage as a later clinical sequelae of inflammation.