A 70-year-old patient came to our service with decreased visual acuity of the left eye.
Personal history included type 2 diabetes mellitus, dyslipidemia, hypertension and allergy to pyrazolones.
The examination showed a corrected visual acuity of 0.5 in right eye and 0.1 in left eye.
Anterior pole examination revealed incipient opacity of the lens in both eyes.
Intraocular pressure of 16 mm Hg in both eyes.
The examination of the eye fundus revealed peripapillary retinal pigment epithelium with a white-yellow coloration affecting the nasal retina and temporary vascular arches in both eyes.
He did not present arthritis.
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FFA showed early hypofluorescence and variable late hyperfluorescence of the lesions in both eyes with macular involvement in the left eye.
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The patient was diagnosed with serpiginous choroiditis, being treated with oral corticosteroids in the form of oral prednisone at doses of 1mg/kg/day up to 2 weeks after having obtained a therapeutic response, being at this time 0.5mg.
After 4 weeks, it was reduced to alternate days and at 8 weeks it was reduced to 0.1mg/kg/day, establishing stable visual acuity.
The patient was referred to the Internal Medicine Department for insulin dose adjustment at the beginning of corticoid treatment.
Six months later, the patient came to the Service of Orthopedics by metrorrhagia and, after examination, developed uterine cervical carcinoma with involvement of the lower third of the vagina.
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The patient was referred to the local emergency department where she began treatment with 40mg methylprednisolone intramuscularly for 3 days a week associated with chemotherapy and radiotherapy for 5 weeks.
Two months later, due to the imminent macular involvement of the second eye prednisone two months after treatment, azathioprine was reduced at a dose of 1.5mg/kg/day, which was reduced to 1mg/kg/day.
The patient died one year later due to multiple organ failure.
