This 38YO male presented with 6 months of bilateral vision loss. Vision was 20/80 OU.
Color imaging shows multiple symmetrical yellowish subretinal variably round lesions centered in each superior macula and extending superiorly. Confluent subretinal vitelliform material is settled in the inferior maculas. This material is markedly hyper-autofluorescent. On OCT, the outer retina is diffusely infiltrated by this hyperreflective material, with associated serous macular detachments.
Oncologic workup was completely negative. When last examined 18 months later, vision was 20/30 OD and 20/30 OS. Color imaging shows remodeling of both the superior macular lesions and the inferiorly layered vitelliform material. The subretinal fluid is resolved with variable outer retinal band defects.
Learning Points:
Acute exudative polymorphous vitelliform maculopathy (AEPVM) is a rare condition characterized by acute vision loss from multifocal serous retinal detachments that later progress to subretinal vitelliform lesions. Initially, serous detachments can mimic central serous retinopathy, including choroidal thickening. The condition is often self-limiting, and vision usually recovers within several months. The yellow vitelliform lesions may take 1-2 years to completely resolve. These patients need a systemic workup for metastatic disease, since paraneoplastic retinopathy, including metastatic melanoma, can mimic idiopathic AEPVM.
