DOI: 10.36347/sjmcr.2018.v06i03.025

Pages: 207-209

A 28-year- old Malay male with 6/9 OU vision was incidentally found to have hyper pigmented clumps at end retinal vascular arcades bilaterally with surrounding chorioretinal thinning and diagnosed to have pigmented parvenus retinochoroidal atrophy. He presented a year later with left eye blurring of vision of two weeks with vision of 6/12 OS, occasional fine anterior chamber and anterior vitreous cells with inferior exudative retinal detachment. Fluorescein angiography showed vasculitis at terminal vessels. Blood investigations for inflammatory markers and tests for tuberculosis were negative. Herpes simplex virus, Epstein-Barr virus and cytomegalovirus IgG were positive with a negative IgM. Based on a similar case found in literature, the patient was started on anti-tubercular medication. He showed initial improvement but anterior segment inflammation persisted and oral Azathioprine was started. Upon completion of anti-tubercular medication, vision remained at 6/24 OS. The patient’s inferior exudative retinal detachment persisted and anterior segment inflammation was 3+. We then considered a viral aetiology and twice daily dose of 900mg oral valganciclovir was started. His inflammation improved with occasional residual anterior chamber cells. The patient’s subretinal fluid became more shallow and vision improved to 6/12 OS. PPRCA occurs bilaterally, more often found in young men and is usually an incidental finding. PPRCA with inflammation may present atypically, and viral aetiology should be entertained for PPRCA with active inflammation even when serological evidence is not suggestive.