Relentless Placoid Chorioretinitis Responsive to Intravitreal Triamcinolone and Systemic Adalimumab

Abstract

Purpose: We describe a case of relentless placoid chorioretinitis that was responsive to intravitreal triamcinolone (IVT) and systemic adalimumab, but suboptimally responsive to oral prednisone. Methods: Interventional case report. Results: A 23-year-old woman presented with macular placoid chorioretinitis in the left eye and visual acuity of finger counting at 3 feet. Despite a 2-week course of 60mg oral prednisone, the choroiditis expanded dramatically in the mid-periphery. She was admitted to the hospital for high-dose intravenous corticosteroids, which stopped progression of disease. After discharge, the patient was started on adalimumab and restarted oral prednisone, however upon resumption of oral prednisone 60mg, the disease started to progress again over the next 2 weeks. An intravitreal injection of triamcinolone (IVT) 2mg was given, which halted progression of the disease for at least 9 weeks, at which time it was felt that the adalimumab started to also have an effect. Visual acuity 9 weeks after IVT had improved to 20/20. The patient was lost to follow-up after this point. Conclusion: This is a case of relentless placoid chorioretinitis that continued to progress despite high-dose oral corticosteroids, but which responded to intravitreal triamcinolone and systemic adalimumab. This indicates that intravitreal corticosteroids may represent an alternative treatment option to oral corticosteroids in the short-term management of macula-threatening non-infectious chorioretinitis, particularly in patients with a sub-optimal response to oral corticosteroids.