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Spectral Domain Optical Coherence Tomography and Autofluorescence in a Case of Acute Posterior Multifocal Placoid Pigment Epitheliopathy Mimicking Vogt-Koyanagi-Harada Disease: Case Report and Review of Literature

Purpose: To report a case of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) with exudative retinal detachment, simulating acute Vogt-Koyanagi-Harada (VKH) disease and to review relevant imaging literature. Methods: Ophthalmologic examination, laboratory evaluation, fluorescein angiography, and B-scan ultrasonography performed at baseline, as well as spectral domain optical coherence tomography (OCT) and fundus autofluorescence performed upon initial presentation and at 5-day, 1-month, and 3-month follow-up. Results: OCT demonstrated outer retinal hyperreflectance and subretinal fluid in the acute phase that disappeared 5 days later. Choroidal thickening was noted on OCT and ultrasonography. Retinal pigment epithelium lesions were hypoautofluorescent acutely but became hyperautofluorescent later in the disease course. Conclusions: At presentation, there can be considerable overlap in both clinical and imaging findings in APMPPE mimicking acute VKH, making it difficult to differentiate these two entities. Cerebral spinal fluid analysis and follow-up examinations could help in arriving at proper diagnosis.