Birdshot Chorioretinopathy: A Case Report

Birdshot chorioretinopathy is a well-known yet poorly studied form of posterior uveitis characterized by multiple, distinct, hypopigmented choroidal lesions and strongly associated with human leukocyte antigen (HLA)-A29. We report the case of a 54-year-old woman with no particular pathologic history who was admitted 3 weeks ago for visual acuity decrease with floaters in both eyes. Ophthalmologic examination revealed visual acuity of 6/10 on the right and 4/10 on the left, bilateral hyalitis without signs of anterior uveitis, which was confirmed by further examination and especially by fluorescein angiography showing bilateral papilledema and signs of vasculitis with intertwining of the vascular axes and diffusion in the late phase. Optical coherence tomography (OCT) showed cystoid macular edema in the left eye. Biological tests such as serologies (toxoplasmosis, syphilis, cytomegalovirus), tuberculosis tests, angiotensin converting enzyme, HLA B27, B51, which are all normal. Cerebro-orbital MRI was normal. Depending on the retinal lesions and angiographic aspect, HLA A29 was requested with positive results. Considering this finding, bilateral disease, fluorescein angiography images, and positive result of HLA A29, the diagnosis of Birdshot chorioretinopathy was confirmed. The patient was treated with immunosuppressants and systemic corticosteroids.