A 70-year-old patient came to our department due to a decrease in visual acuity in the left eye.
His personal history included type 2 diabetes mellitus, dyslipidaemia, hypertension and allergy to pyrazolones.
On examination, corrected visual acuity was 0.5 in the right eye and 0.1 in the left eye. Examination of the anterior pole revealed incipient lens opacity in both eyes. Intraocular pressure was 16 mm Hg in both eyes. Fundus examination showed peripapillary chorioretinal atrophy with a yellowish-white discolouration affecting the nasal retina and temporal vascular arcades in both eyes, affecting the macula in the left eye. There was no vitritis.

FFA showed early hypofluorescence and variable late hyperfluorescence of the lesions in both eyes with macular involvement in the left eye.

The patient was diagnosed with serpiginous choroiditis, and treatment was started with oral corticosteroids in the form of oral prednisone at a dose of 1mg/kg/day until 2 weeks after a therapeutic response had been obtained, at which point the dose was reduced to 0.5mg/kg/day. Subsequently at 4 weeks it was reduced every other day and at 8 weeks it was reduced to 0.1mg/kg/day, and visual acuity remained stable. The patient was referred to the Internal Medicine Department for adjustment of the insulin doses due to the start of corticosteroid treatment.
Six months later, the patient consulted the gynaecology department for metrorrhagia, which revealed an advanced carcinoma of the uterine cervix with involvement of the lower third of the vagina.

The patient was referred to the Oncology Department, which began treatment with 40mg of intramuscular methylprednisolone for 3 days a week associated with chemotherapy and radiotherapy for 5 weeks.
Two months later, given the imminent macular involvement of the second eye, azathioprine was added to the treatment at a dose of 1.5mg/kg/day, which was reduced to 1mg/kg/day after two months and oral prednisone was reduced according to protocol4.
The patient died one year later due to multi-organ failure.

