A Case of Resistant Serpiginous Choroiditis Successfully Treated with Chlorambucil Monotherapy
Chlorambucil in Serpiginous choroiditis
DOI:
https://doi.org/10.62856/djcro.v9.67Abstract
Purpose: Serpiginous Choroiditis is an inflammatory condition that presents with etiology such as choroidal inflammation, leading to the loss of the choriocapillaris, atrophy or damage to the overlying retinal pigment epithelium. Diagnosis of serpiginous choroiditis is made from retinal imaging such as optical coherence tomography, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, and OCT angiography. Patients with serpiginous choroiditis present with symptoms such as metamorphopsia, scatoma, and reduced central vision. Treatment can range from high dose oral corticosteroid, intravitreal steroid, or immunosuppressive drugs such as chlorambucil.
Methods: A 70-year-old male presented to our clinic with blurry vision and metamorphopsia in his right eye.
Results and Discussion: Slit lamp exam was normal; however, Fundus exam revealed peripapillary atrophy extending from the disk nasally and supratemporally and presence of an elevated grayish lesion supratemporal to the optic nerve head in the macula with pigment. Optical coherence tomography revealed subretinal fluid within the macula and near the disk. A complete uveitis workup was completed with serological markers within normal range confirming the diagnosis of SC. The patient was started on oral corticosteroid and administered intravitreal bevacizumab. He was later started on chlorambucil with weekly dose adjustments to a dose of 24 mg daily with sustained WBC count between 3000-4500 cells/μl for 12 weeks with no recurrence of subretinal fluid. This treatment requires further study but provides a foundation for larger patient studies.
Conclusion: chlorambucil monotherapy, has shown promise as a successful approach to induce durable remission and potentially cure serpiginous choroiditis.
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