Background:

Hepatitis C is an infection caused by Hepatitis C virus (HCV) with both hepatic and extrahepatic manifestations and involving 3% of world population. Chronic infection develops in 70- 80% of the patients. Current recommended treatment is in a combination of ribavirin and peginterferon alfa (PEG-IFN) which is effective in less than 50% of HCV genotype 1 infection. Novel therapy with protease inhibitors such as Telaprevir has showed promising results when added to current therapy. According to the literature, the most common ocular manifestations related to HCV infection or to its treatment include dry eye syndrome and ischemic retinopathy (HCV-induced vasculitis and/or Interferon treatment).

Settings:

Ophthalmology Department, Centro Hospitalar do Porto Hospital Santo Antonio, Oporto, PORTUGAL.

Methods:

The authors describe the ocular findings observed in a routine exam of a female with chronic hepatitis C virus (HCV) proposed for a new triple treatment with no actual ophthalmological complaints. Results and

Discussion:

A 54 year old female with chronic HCV infection was referred to our department before starting a novel cycle of triple treatment with ribavirin, PEG-IFN and telaprevir. She had no ophthalmological complaints and did not recall any previous ocular disturbances. Bilateral fundus examination revealed hyperpigmented, chorioretinal confluent lesions with irregular distribution in the posterior pole sparing central macular area, without hemorrhages, exudation, signs of vasculitis or active chorioretinitis. These lesions were considered to be sequelae of an Acute posterior multifocal placoid pigment epitheliopathy (APMPPE). No significant abnormalities were noticed on OCT scan. Fluorescein and indocyanine green angiography did not reveal any signs of active disease. After no clear ophthalmological contraindication, the triple antiviral HCV treatment was started and the RNA-HCV became undetectable. At the moment, the patient is asymptomatic and the fundocospic findings remain stable.

Conclusions:

This case shows how an asymptomatic APMPPE may be accidentally diagnosed in a routine ophthalmological examination. The significance of this finding, in the context of the HCV infection, is still unclear.