GRAFT-VERSUS-HOST DISEASE PANUVEITIS AND BILATERAL SEROUS DETACHMENTS: MULTIMODAL IMAGING ANALYSIS. (2017)

• Record Type: Journal Article
• Authors: Jung, Jesse J.; Chen, Michael H.; Rofagha, Soraya; Lee, Scott S.
• Is Part Of: Retinal cases & brief reports. Volume 11(2017:Winter)Supplement 1
• Publication Date: 2017
• Subjects: acute myeloid leukemia -- allogenic bone marrow transplant -- autofluorescence -- graft-versus-host disease -- multimodal imaging -- panuveitis -- spectral domain optical coherence tomography -- swept-source optical coherence tomographic angiography -- serous retinal detachment -- Vogt-Koyanagi-Harada syndrome; Retina -- Diseases -- Periodicals; Retina -- Periodicals; Retinal Diseases -- Periodicals; Retina -- Case Reports; Retinal Diseases -- Case Reports; 617.7
• DOI: 10.1097/ICB.0000000000000404
• Languages: English
• ISSNs: 1935-1089

Abstract

Abstract : Purpose: To report the multimodal imaging findings and follow-up of a case of graft-versus-host disease–induced bilateral panuveitis and serous retinal detachments after allogenic bone marrow transplant for acute myeloid leukemia. Methods: A 75-year-old black man presented with acute decreased vision in both eyes for 1 week. Clinical examination and multimodal imaging, including spectral domain optical coherence tomography, fundus autofluorescence, fluorescein angiography, and swept-source optical coherence tomography angiography (Investigational Device; Carl Zeiss Meditec Inc) were performed. Results: Clinical examination of the patient revealed anterior and posterior inflammation and bilateral serous retinal detachments. Ultra-widefield fundus autofluorescence demonstrated hyperautofluorescence secondary to subretinal fluid; and fluorescein angiography revealed multiple areas of punctate hyperfluorescence, leakage, and staining of the optic discs. Spectral domain and enhanced depth imaging optical coherence tomography demonstrated subretinal fluid, a thickened, undulating retinal pigment epithelium layer, and a thickened choroid in both eyes. En-face swept-source optical coherence tomography angiography did not show any retinal vascular abnormalities but did demonstrate patchy areas of decreased choriocapillaris flow. An extensive systemic infectious and malignancy workup was negative and the patient was treated with high-dose oral prednisone immunosuppression. Subsequent 6-month follow-up demonstrated complete resolution of the inflammation and bilateral serous detachments after completion of the prednisone taper over a 3-month period. Conclusion: Graft-versus-host disease panuveitis and bilateral serous retinal detachments are rare complications of allogenic bone marrow transplant for acute myeloid leukemia and can be diagnosed with clinical and multimodal imaging analysis. This form of autoimmune inflammation may occur after the recovery of T-cell activity within the donor graft targeting the host. Infectious and recurrent malignancy must be ruled out before initiation of immunosuppression, which can affectively treat this form of graft-versus-host disease. Abstract : In this study, the authors present a case of panuveitis and bilateral serous retinal detachments (SRDs) secondary to graft-versus-host disease after allogenic bone marrow transplant for acute myeloid leukemia. Multimodal imaging with autofluorescence, spectral domain optical coherence tomography, fluorescein angiography, and swept-source optical coherence tomographic angiography demonstrated inflammation and SRDs that resolved after high-dose corticosteroid immunosuppression.