ACUTE POSTERIOR MULTIFOCAL PLACOID PIGMENT EPITHELIOPATHY

APMPPE is a white dot syndrome that is usually bilateral affecting younger people (in their 20's to 50s). It is associated with HLA-B7 and HLA-DR2. It sometimes follows a flu and may occur in association with tuberculosis, anti-hepatitis B vaccination, mumps, Wegener granulomatosis, polyarteritis nodosa, ulcerative colitis, sarcoidosis, and Lyme disease.

It impairs vision causing paracentral scotomas and the sensation of flashes of light. It can cause mild vitritis (vitreous cells) and creamy white lesions starting in the posterior pole and progressing to the peripheral retina, eventually causing RPE changes of varying degrees.

The visual acuity recovers within several months, but the scotomas may persist. Fluorescein angiography reveals early hypofluorescence of the lesions followed by later hyperfluorescence.

Differential diagnosis includes serpiginous choroidopathy (which occurs in older people), multiple evanescent white dot syndrome (which is usually unilateral with smaller lesions), Harada disease (which affects specific ethnic groups and may have exudative retinal detachment), and others (neuroretinitis, multifocal choroiditis with panuveitis, sarcoid, syphilis, sympathetic ophthalmitis, and metastatic choroidal infiltrates.