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Recurring meningoencephalitis in sinusitis-associated acute posterior multifocal placoid pigment epitheliopathy under prednisone tapering

Holger Joswig, Carole Flückiger, Andreas Infanger, Barbara Tettenborn & Ansgar Felbecker

abstract The authors describe a case of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) with recurrent neurological
complications.
A 24-year-old man experienced subacute bilateral visual loss. Based on the characteristic fi ndings in funduscopy and fluorescin angiography and after the exclusion of the differential diagnoses, APMPPE was diagnosed. During the course of the disease recurrent episodes of meningitis and encephalitis occurred when tapering of prednisone was attempted. Secondary to encephalitic lesions, the patient developed partial epileptic seizures, which made an anticonvulsive medication necessary. The authors considered a chronic sinusitis to be an aetiological factor of the underlying autoimmune process. Due to the complicated course of APMPPE, they decided to start long-term immunosuppressive therapy with azathioprine under which the patient remained stable and prednisone could be tapered successfully.
Neurological complications of APMPPE are rare. Nevertheless, this case demonstrates that long-term immunosuppressive treatment might be necessary to prevent recurrent neurological complications in some cases.
   
keywords APMPPE, encephalitis, meningitis
   
citation Joswig H, Flückiger C, infanger a, Tettenborn B, Felbecker A. Recurring meningoencephalitis in sinusitis-associated acute posterior multifocal placoid pigment epitheliopathy under prednisone tapering. BMJ case reports 2011;.
   
type journal paper/review (English)
date of publishing 10-5-2011
journal title BMJ case reports
DOI 10.1136/bcr.02.2011.3820
contact Ansgar Felbecker