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Uvéite ou pseudouvéite: mimant une atrophie rétinochoroïdienne paraveineuse

Our aim is to describe an atypical case of a 25-year-old man with a random finding of asymptomatic disseminated perivascular lesions in the fundus examination, with an atypical pattern resembling as a non-pigmented paravenous chorioretinal atrophy, and a positif IgG serology for Lyme disease.

A 25-year-old man presented with minor visual blur of his right eye while looking at his cell phone since the last few days. He had no past ocular history and was in good general health and with a clear family history. The visual acuity was 1.0 in the right eye with difficulty in reading the first letters, and 1.25 in the left eye. The intraocular pressure was normal in both eyes. Slit-lamp examination revealed clear and calm anterior segments and vitreous. Fundoscopy showed a macular and perivascular retinal hypopigmentation following the arcades and peripheral atrophic perivenular lesions. The lesions where hypo-autofluorescent with a perimetric hyper-autofluorescence and a marked hypo-autofluorescence of the optic nerve symmetrically. Macular OCT revealed a complete disruption of the ellipsoid zone and the outer nuclear layer on the right eye, while in the left eye there was a mild attenuation of parafoveal photoreceptors. Fluorescein angiography showed pigment epithelium disruption with a diffuse pseudovasculitis aspect and peripheral perivascular atrophic lesions. The indocyanine green angiography was remarkable of a window effect.

The extensive work-up for auto-immune and infectious diseases was positive for IgG Borrelia with IgM just above the normal limits. A normal full-field electro-retinogram excluded a retinal dystrophy. Cerebral magnetic resonance imaging, and pulmonary imaging were normal and lumbar puncture did not confirm a neuroborreliosis.

This atypical bilateral periphlebitis had an important discrepancy between clinical signs and angiographic images.The presence of a positive serology for Lyme disease may suggest an infectious origin of the lesions.  

The clinical characteristics of this case are similar with a pigmented paravenous retinochoroidal atrophy, but the macular implication, the absence of pigmentary lesions and the normal electroretinogram make it a separate entity. In chronic uveitis atrophy of the pigmentary epithelium may lead to similar pattern between chronic uveitis and ocular dystrophies.