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Title

Acute bilateral serous retinal detachments with spontaneous resolution in a six-year-old boy

Purpose	To report the youngest patient with a tentative diagnosis of AEPVM
Methods	Case report
Results	A healthy boy without relevant medical history or recent travel presented with acute blurriness, metamorphopsia and scattered scotomas. He had suffered from a cold a few weeks before. Vision was Snellen 0.6 RE and 0.16 LE. Anterior segment examination and IOP were normal. Multiple large serofibrinous RDs with choroidal thickening and mildly hyperautofluorescent yellow subretinal dots OU were seen on examination. FA revealed small leakage points at the level of the detachments, limited staining of the optic disc in the LE and a masking effect due to the neurosensory detachments (ICG was not performed). A total systemic clinical work-up was negative. Spontaneous improvement and resolution of lesions occurred over the next couple of weeks, without treatment. Our tentative diagnosis is acute exudative polymorphous vitelliform maculopathy. Its etiology remains unclear, though infectious, inflammatory and paraneoplastic causes have been suggested. Treatment is still controversial, with little evidence for the efficacy of corticosteroids. We also considered an atypical presentation of Vogt-Koyanagi-Harada disease, ocular manifestation of tuberculosis and acute posterior multifocal placoid pigment epitheliopathy, but these entities didn’t fully fit the clinical picture.
Conclusion	This case is suggestive of the subtype ‘bleb-like lesions along the vascular arcades’ of AEPVM. This entails bilateral multifocal serous RDs and accumulation of yellow lipofuscin-rich subretinal lesions, with spontaneous fast recovery of choroidal and RPE function. We hypothesize transient activation of inflammatory cells in the choroid, though the underlying pathophysiological mechanism remains unclear.
Conflict of interest	No

Authors 1

Last name	VAN CAMP
Initials	S
Department	UZ Leuven
City	Leuven