A 36-year-old emmetropic woman came to our emergency department for blurred vision without a previous episode of influenza in January 1992. On examination she had visual acuity (VA) in the right eye (RA) 20/30 and in the left eye (LA) 20/60, anterior chamber cells of 1+ in both eyes (AO) and multiple white dots of 100-200 microns, more numerous in the area temporal to the macula in the AO. Angiofluoresceinography (AFG) showed multiple hyperfluorescent spots. Treatment was started with 40 mg per day of methylprednisolone IM (Urbason® soluble 40 mg, Aventis Pharma S.A., Madrid), atropine sulphate 10 mg/ml topical (Atropina® 1%, Alcon Cusí S.A., Barcelona) every 12 hours and dexamethasone 1 mg/ml topical (Maxidex®, Alcon Cusí S.A., Barcelona) every 6 hours. After two weeks of treatment he achieved a VA of 20/20 in AO. The systemic tests requested (basic laboratory tests, chest X-ray, luetic serology, angiotensin converting enzyme and Mantoux) were negative.

Four years later he presented a new relapse, more marked in the OD, with visual loss at 20/60 OD and 20/30 OI, with no evidence of campimetric alterations. The same systemic regimen was started as in the previous episode with complete visual recovery after one month of treatment, although some white patches and upper temporal peripapillary pigment persisted in the OD.
In September 2001 he presented a new, milder flare-up. VA was 20/25 OD and 20/20 OI, and funduscopic examination revealed yellowish-white spots distributed over the posterior pole and alteration of the macular retinal pigment epithelium (RPE) AO. Topical and systemic corticosteroid treatment was started as in the first episode. Three weeks after the onset of the flare, VA decreased to 20/40 OD and 20/60 OI, so it was decided to add oral methotrexate (Methotrexate Lederle®, Whyeth, Madrid) at low doses. An HLA A29 study was requested, which was negative.
In April 2005, the patient remained asymptomatic, with VA at 20/30 OD and 20/25 OI. Fundus examination showed a nasal juxtafoveolar neuroepithelium lifting in the OD; optical coherence tomography confirmed the suspected diagnosis of ARVCM. The patient refused treatment, but five months later, with a VA in the RA of 20/60, treatment of the SNVRS was started with photodynamic therapy (Visudyne®, Novartis Farmacéutica S.A., Barcelona) and intravitreal triamcinolone acetonide 4 mg in 0.1 ml (Trigon depot® 40 mg/ml, Bristol-Myers Squibb, Madrid). VA in the OD improved to 20/40".

Currently, the patient has VA 20/40 OD and 20/25 OI, faint yellowish-white spots in the posterior pole of both eyes, AO peripapillary atrophy lesions, with involvement of the papillomacular bundle in the OD and several inactive whitish lesions, inferior to the macula in the OI.

