Birdshot chorioretinopathy in an HLA-A29 positive Asian patient

Jonathan Regenold; Hashem Ghoraba; Amir Akhavanrezayat; Prapatsorn Ongpalakorn; Vahid Bazojoo; Diana V Do; Quan Dong Nguyen; Christopher Or

doi:10.1016/j.ajoc.2023.101802

Birdshot chorioretinopathy in an HLA-A29 positive Asian patient

Am J Ophthalmol Case Rep. 2023 Jan 18:29:101802. doi: 10.1016/j.ajoc.2023.101802. eCollection 2023 Mar.

Authors

Jonathan Regenold¹, Hashem Ghoraba², Amir Akhavanrezayat², Prapatsorn Ongpalakorn², Vahid Bazojoo², Diana V Do², Quan Dong Nguyen², Christopher Or²

Affiliations

¹ University of Cincinnati College of Medicine, Cincinnati, OH, USA.
² Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA.

Abstract

Purpose: To present a case of birdshot chorioretinopathy (BCR) in a Chinese patient with HLA-A29 positivity.

Observations: A 45-year-old Chinese female presented at a tertiary Ophthalmology Clinic with complaints of frequent headaches as well as blurred vision, photophobia, and pressure in the left eye (OS). The patient had a significant ocular history of left orbital cavernous hemangioma status post lateral orbitotomy and resection. Uncorrected visual acuity was 20/20 in the right eye (OD) and 20/40 in OS (pinhole 20/30). Funduscopic examination demonstrated optic disc edema, left eye worse than right eye, and vascular tortuosity in both eyes (OU). Late phase fluorescein angiography (FA) showed extensive perivascular and optic disc leakage and peripheral capillary leakage in OU. Laboratory evaluations were positive for human leukocyte antigen-A29 (HLA-A29). The patient was started on 40 mg prednisone daily; mycophenolate mofetil 500 mg twice daily was subsequently added.At the 3-month consultation visit to the Uveitis Clinic, dilated funduscopic examination revealed 1+ vitreous cells and improved optic disc edema in OU. FA showed improved vascular and optic disc leakage in OS but worsened leakage in OD. At this point, indocyanine green angiography (ICGA) was ordered which revealed hypocyanescent lesions throughout the choroid that were centered on the optic disc, supporting and confirming the diagnosis of BCR.

Conclusions and importance: The index patient is the first reported case of BCR in an HLA-A29 positive Asian patient.

Keywords: Asian; Birdshot; Chinese; HLA-A29; Uveitis.

Publication types

Case Reports

Grants and funding

P30 EY026877/EY/NEI NIH HHS/United States