Diana Iturralde Errea, MD (Bilbao, Spain), Enrique Diaz de Durana, MD (Bilbao, Spain), Jose Luis Salazar, MD (Bilbao, Spain), Maria Luisa Fernandez Ares, MD (Bilbao, Spain)

PURPOSE:

This case suggest that the presence of a bilateral serous macular detachment in the absence of other typical signs already described might be one of the earliest signs of the disease.

METHODS:

Fundus examination OD revealed a serous macular detachment as an isolated sign. No acute chorioretinal lesions or vasculitis were noted. Fluorescein angiogram showed a swelling of the optic nerve associated with a vasculitis of the superior arcade and a subtle and diffuse leakage from the macular capillaries. No hyper or hypofluorescence spots were observed. Optical coherence tomography (OCT) revealed a posterior hyaloid attached to the macula. Indocyanine green angiography of both eyes appeared normal. The OCT of the OI revealed a posterior hyaloid detached.

RESULTS:

A complete work-up study revealed the presence of a possitive HLA-A29. To our knowledge, the only macular involvement that has been described in Birdshot retinochoroidopathy includes both complications of the disease, namely cystic macular edema and epiretinal membrane. We believe that this is the first reported case of birdshot with a bilateral macular detachment as an initial presentation. Clinical and imaging tests were not consistent with the diagnosis. Futhermore, in this case the OCT confused us instead of being helpful to arrive to a correct diagnosis.

CONCLUSION:

This case suggest that the presence of a bilateral serous macular detachment in the absence of other typical signs already described might be one of the earliest signs of the disease, and that a mild bilateral vitritis with macular detachment in the absence of other clinical and angiographic signs should be enough to rule out a diagnosis of an atypical case of birdshot
retinochoroidopathy.