APMPPE Presenting with BALAD: Imaging Features for Differential Diagnosis of Choroiditis and Non-Invasive Follow-Up

PURPOSE: To describe the diagnostic and therapeutic management of a case of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) presenting with unilateral bacillary layer detachment (BALAD) in a young Caucasian woman. METHODS: Case report. RESULTS: A 29-year-old female patient presented with bilateral fine keratic precipitates (KPs) and anterior chamber cells, along with a yellowish plaque-like macular lesion in the right eye. Multimodal imaging (MMI) was performed, including color fundus photography, optical coherence tomography (OCT), OCT angiography (OCT-A), fundus autofluorescence (FAF), fluorescein angiography (FA), and indocyanine green angiography (ICGA). MMI revealed a unilateral BALAD with bilateral choroidal involvement. Serologic testing for infectious diseases was negative, and biochemical blood tests were unremarkable.Based on the clinical findings, MMI features, and laboratory results, a diagnosis of APMPPE was established. The patient was successfully treated with systemic corticosteroid therapy, achieving sustained quiescence during long-term follow-up and partial restoration of the ischemic lesions. CONCLUSION: BALAD is an OCT finding that can be associated with various underlying etiology. A thorough review of the patient's history and symptoms, along with comprehensive MMI, is essential to establish the correct diagnosis and non-invasively monitor disease remission during follow-up.