Journal of Postgraduate Medicine
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Year : 2022  |  Volume : 68  |  Issue : 4  |  Page : 245-246  

Bilateral asymmetrical choroidal vitiligo

GJ Manayath, S Verghese, P Chandrakanth, HV Gosalia 
 Department of Retina and Vitreous, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India

Correspondence Address:
S Verghese
Department of Retina and Vitreous, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu
India




How to cite this article:
Manayath G J, Verghese S, Chandrakanth P, Gosalia H V. Bilateral asymmetrical choroidal vitiligo.J Postgrad Med 2022;68:245-246


How to cite this URL:
Manayath G J, Verghese S, Chandrakanth P, Gosalia H V. Bilateral asymmetrical choroidal vitiligo. J Postgrad Med [serial online] 2022 [cited 2023 Jan 31 ];68:245-246
Available from: https://www.jpgmonline.com/text.asp?2022/68/4/245/358383


Full Text



A 50-year-old woman of Indian origin was referred to us to rule out choroidal melanoma in both eyes. She was asymptomatic, and there was no history of intraocular inflammation, trauma, or any systemic illnesses. On examination, her best corrected Snellen's visual acuity was 20/20 in both eyes (BE) with a refractive correction of +0.5D. Anterior segment examination was unremarkable with brown color irides in BE [Figure 1]a and [Figure 1]b. Wide-field fundus imaging of the right eye (RE) revealed choroidal hypopigmentation of the nasal half of the fundus with its irregular border passing temporal to the fovea and extending to the inferior and superior periphery measuring 35 mm in diameter. The left eye (LE) fundus revealed choroidal hypopigmentation with ragged irregular margins present only in the superonasal quadrant, with a small linear extension toward the optic disc measuring 7 mm in diameter [Figure 2]a and [Figure 2]b. Short-wavelength fundus autofluorescence (FAF) revealed normal foveal hypoautofluorescence in BE [Figure 2]c and [Figure 2]d. Spectral-domain optical coherence tomography (SD-OCT) of BE revealed a normal foveal contour with a normal retinal pigment epithelium, and an increased patchy choroidal hypertransmission was seen between the fovea and nasal macula in BE. Additionally, SD-OCT in the RE revealed mild choroidal thinning in the region of depigmentation [Figure 2]e and [Figure 2]f. Detailed physical examination did not reveal any cutaneous hypopigmentation or white forelock [Figure 1]e. Based on history, systemic examination, and multimodal imaging, she was diagnosed with BE asymmetric choroidal vitiligo and was advised observation and close follow-up.{Figure 1}{Figure 2}

Primary acquired choroidal vitiligo manifests as flat hypopigmentation of the normally pigmented choroid and occurs as an idiopathic condition without any preceding inflammation.[1] This condition, although rare, has been described previously in case reports to be associated with cutaneous vitiligo, with the pathology being the destruction of the choroidal and cutaneous melanocytes which are both derived from the neural crest.[1],[2],[3],[4] Previous reports have described the choroidal hypopigmentation to be symmetrical or asymmetrical between the eyes, occurring along a sector of the fundus, presenting as patchy areas of hypopigmentation, and occurring in an X-shaped pattern.[1],[2],[3],[4] Multimodal imaging findings have further revealed a normal retinal architecture on OCT and normal retinal pigment epithelial function on FAF, although scleral hyperautofluorescence was noted in the region of the depigmented choroid and mild choroidal hyperfluorescence in the region of vitiligo on fundus fluorescein angiogram.[1]

Wibbelsman et al.[5] reported symmetrical sectoral choroidal hypopigmentation along with multimodal imaging findings in a Caucasian woman without cutaneous vitiligo or white forelock. Similar to their case, we describe the multimodal imaging findings of an Indian woman with choroidal hypopigmentation without cutaneous vitiligo. She did not have a history of uveitis, tinnitus, headache, meningismus, progressive vitiligo, or rheumatological symptoms. Unlike the case reported by Wibbelsman et al.,[5] a gross asymmetry in the pattern and extent of choroidal hypopigmentation was seen in the present patient with extensive involvement in the RE and only a sectoral involvement in the LE. Visual function was preserved in the present patient with a normal retinal architecture on SD-OCT, although mild choroidal thinning was noted at the region of hypopigmentation. FAF in the present patient did not reveal scleral hyperautofluorescence. Nevertheless, this is the first report of asymmetrical choroidal vitiligo seen in an Indian woman without associated cutaneous vitiligo and this may represent either an early sign or a limited form of vitiligo.

Declaration of patient consent

The authors certify that appropriate patient consent was obtained.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Shields CL, Ramasubramanian A, Kunz WB, Aggarwal E, Shields JA. Choroidal vitiligo masquerading as large choroidal nevus: A report of four cases. Ophthalmology 2010;117:109-113.e3.
2Kim M, Kwon JW, Park YH. Atypical Pattern of Choroidal Hypopigmentation with Cutaneous Vitiligo. Korean J Ophthalmol 2019;33:99-100.
3Vingerling JR, Owens S, van der Meijden WI, Hoyng CB, Bird AC. Cutaneous vitiligo associated with choroidal hypopigmentation. Eye (Lond) 2004;18:939-40.
4Ciardella AP, Horsley MB, Brown DM. Hypopigmentary fundus changes seen with cutaneous vitiligo. Arch Ophthalmol 2007;125:576.
5Wibbelsman TD, Jenkins TL, Shields CL. Sectoral choroidal hypopigmentation. Ophthalmology 2019;126:711.

 
Tuesday, January 31, 2023
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