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Year : 2020  |  Volume : 68  |  Issue : 9  |  Page : 1942-1943

Lichen planus and multifocal choroiditis - A diagnostic dilemma

1 Department of Ophthalmology, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
2 Department of Neurology, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India

Date of Submission16-Mar-2020
Date of Acceptance06-Jun-2020
Date of Web Publication20-Aug-2020

Correspondence Address:
Dr. Mayur R Moreker
4th Floor, New Wing, Bombay Hospital. 12, New Marine Lines, Mumbai - 400 020, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_563_20

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Keywords: Azathioprine, lichen planus, multifocal choroiditis

How to cite this article:
Moreker MR, Sharma TR, Pardasani VP. Lichen planus and multifocal choroiditis - A diagnostic dilemma. Indian J Ophthalmol 2020;68:1942-3

How to cite this URL:
Moreker MR, Sharma TR, Pardasani VP. Lichen planus and multifocal choroiditis - A diagnostic dilemma. Indian J Ophthalmol [serial online] 2020 [cited 2020 Sep 28];68:1942-3. Available from: http://www.ijo.in/text.asp?2020/68/9/1942/292579

A 24-year-old gentleman had a right headache and MFC; for 1 year [Figure 1]a; being on AKT for 3 weeks with further worsening. Fundus fluorescein angiography (FFA) [Figure 1]b; optical coherence tomography (OCT), [Figure 1]c and B-Scan [Figure 1]d had been done. Serum angiotensin-converting enzyme (ACE), serum uric acid, and QuantiFERON TB Gold Test were normal. Mantoux was 19 mm [48 h/5 tuberculin units (TU)]. Oculus sinister (OS) was normal. On presentation to us, OD had finger counting close to face with congestion; mild relative afferent pupillary defect (RAPD); painful movements; disc edema; peripapillary sub-retinal exudation, and MFC [Figure 1]e. We did contrast magnetic resonance imaging (MRI) brain/orbit, venereal disease research laboratory (VDRL), antinuclear antibody (ANA), antineutrophil cytoplasmic autoantibody (ANCA), and HIV, which were normal. Paradoxical worsening of TB choroiditis (3 weeks AKT) was considered and intravenous methylprednisolone was used. Repeat history-taking, caused him to recall having skin biopsy-proven LP; treated with oral prednisolone; just prior to ocular symptoms; 1 year back. Pursuing the possibility of flare-up of occult systemic TB; after the use of oral steroids to treat LP, a contrast chest CT was done, which was normal. A previously reported; LP associated intraocular inflammation [1] led us to use of azathioprine. One of the treatment protocols could have been the continuation of AKT, but our physician stopped AKT to avoid hepatotoxicity. Intraocular inflammation resolved within 2 months of azathioprine, [Figure 1]f; which was continued for 9 months. At 16 months post cessation of azathioprine; he stays in remission.
Figure 1: (a) Fundus showing fulminant MFC on treatment with tapering oral steroids for one year. (b) FFA showing late hyperfluorescence; pooling; disc leakage. (c) OCT showing choroidal elevation with macular thickening. (d) B-Scan showing grossly thickened choroid with sub-tenons fluid in macular area. (e) Fundus showing disc edema with peripapillary sub retinal exudation and MFC. (f) Fundus showing resolution of inflammation; 2 months on azathioprine

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  Discussion Top

Ocular LP is largely extraocular and involves conjunctiva, cornea, and lacrimal drainage system.[2] The role of cellular immunity in LP and retinal vasculitis [3],[4] was believed to be the cause of their once previously reported association.[1] In our patient; there is a diagnostic dilemma of the mere coexistence of LP and MFC with a temporal dissociation (LP occurring just prior to the onset of ocular symptoms) vs possible association between these two otherwise separate immune-mediated clinical entities.


The authors wish to acknowledge Dr. Avinash Pathengay, for his technical help in the management of this patient.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Dikci S, Genç O, Yilmaz T, Firat PG. Bilateral retinal vasculitis in a patient with lichen planus. Arq Bras Oftalmol 2016;79:402-3.  Back to cited text no. 1
Mohebbi M, Mirghorbani M, Banafshe Afshan A, Towfighi M. Lichen Planus in ocular surface: Major presentations and treatments. Ocul Immunol Inflamm 2019;27:987-94.  Back to cited text no. 2
Gorouhi F, Davari P, Fazel N. Cutaneous and mucosal lichen planus: A comprehensive review of clinical subtypes, risk factors, diagnosis and prognosis. Scientific World J 2014;30:1-22.  Back to cited text no. 3
Walton RC, Ashmore ED. Retinal vasculitis. Curr Opin Ophthalmol 2003;14:413-9.  Back to cited text no. 4


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