Acute Retinal Pigment Epithelitis Dr. Dipankar Das, MS Dr. Rachana Jain, DO, DNB Dr.Harsha Bhattacharjee, MS Sri Sankaradeva Nethralaya, Guwahati, Assam, INDIA

Ocular History 22 year old lady 2-2007: OD blurred vision

March 2007: First Presentation VA: OD 20/20, OS 20/20 No AC, vitreous reaction Fundus: Resolved Multifocal choroiditis OD

March 2007: First Presentation CBC, Chest X Ray, CT Scan Brain and orbit –Normal,VDRL-Non reactive, Mantoux test 9mm induration, FFA Resolving lesions Kept under observation Improvement

After 14 days March 2007 OS Blurred vision VA OD 20/20, OS 20/20 No reaction in AC & vitreous Fundus OS Creamish subretinal lesion with few hyperpigmented dark grey areas surrounded by yellowish white halo. FFA, hypoflourescence surrounded by hyperflourescence in active lesions

After 14 days March 2007 ERG- Normal EOG- Subnormal Left eye CBC, Mantoux, VDRL, CX Ray - Normal Observation

April 2007 VA 20/20 OD, 20/20 OS Resolving lesion left eye

May 2007 OD: 20/20, OS: 20/20 Healed lesion OS

EOG (last follow-up)-OU WNL

Final Diagnosis Acute Retinal Pigment Epithelitis Atypical clinical manifestation immitating MEWDS Acute Macular Neuroretinopathy Acute posterior multifocal placoid pigment epitheliopathy Central serous chorioretinopathy Rubella retinitis No treatment required

Problems Rare New Clinical Entity Subtle fundus changes that can be missed, if not kept in mind.

Conclusion Acute retinal pigment epithelitis or Krill’s disease is a rare, yet relatively new clinical entity (1972) Characterised by Acute inflammation of the retinal pigment epithelium and manifested by transient and subtle alteration at the level of the RPE Needs no treatment, remission and recurrences noted with good visual prognosis

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