Romanian Journal of Ophthalmology, Volume 66, Issue 4, October-December 2022. pp:373-381 CASE REPORT 373 This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2022 The Authors. Romanian Journal of Ophthalmology published by Romanian Society of Ophthalmology Bilateral multifocal and recurrent chorioretinopathy - case report Andreea-Petra Cristea*, Cristina Stan* ** *Department of Ophthalmology, Emergency County Hospital, Cluj-Napoca, Romania **Department of Ophthalmology “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania Accepted: November 13th, 2022 Abstract Objective: The aim of this report is to highlight a rare condition that raises serious diagnosis and treatment difficulties. Case presentation: A 34-year-old male patient presented at the Department of Ophthalmology accusing reduced visual acuity (VA), dyschromatopsia and slight photophobia in his left eye (OS). Posterior pole examination revealed serous retinal detachment superior to the optic nerve head in his right eye (OD) and a well-defined macular oedema in the OS. Optical coherence tomography (OCT) confirmed the presence of subretinal fluid accumulations, fundus fluorescein angiography (FFA) revealed punctate hyperfluorescent pinpoint foci in the macular region of both eyes in the early venous phase and dye pooling in the late phase. The first diagnosis was Probable Vogt-Koyanagi-Harada (VKH) syndrome, but the evolution under corticosteroid therapy and shifting of the position of the serous retinal detachments in time, changed the diagnosis to multifocal, recurrent central serous choroidopathy. The patient received treatment with anti-vascular endothelial growth factor (VEGF) agents and presented multiple episodes of partial remission and shift of the subretinal fluid. Conclusions: The persistent, recurrent, multifocal and bilateral exudative retinal detachments raised significant diagnosis difficulties. In the absence of a well-established treatment, the current prognosis is unfavorable. Keywords: multifocal chorioretinopathy, subretinal fluid, retinal pigment epithelium Abbreviations: MARC = multifocal and recurrent choroidopathy, CSCR = Central Serous Chorioretinopathy, RPE = retinal pigment epithelium, CFH = complement factor H, VA = visual acuity, OD = right eye, OS = left eye, OCT = ocular coherence tomography, VEGF = vascular endothelial growth factor, FFA = Fundus fluorescein angiography, p-ANCA = Perinuclear anti- neutrophil cytoplasmic antibodies, PR3 = IgG antibodies against proteinase 3, ANA = antinuclear antibodies, CIC = Circulating immune complexes, CMV = Cytomegalovirus, VKH = Vogt-Koyanagi-Harada. Introduction Multifocal, recurrent serous chorioretinopathy is a rare pathology first described as an independent entity known as MARC (multifocal and recurrent choroidopathy) syndrome in 1984 [1]. Nowadays, it is considered the rare chronical form of Central Serous Chorioretinopathy (CSCR) affecting most frequently otherwise healthy middle-aged men with Asian descendants. Most of the time, both eyes are affected with an asymmetric pattern of the neurosensory retinal detachments and RPE changes determining reduced visual acuity, blurry vision and dyschromatopsia. The pathogenesis and risk factors of this disease are not yet fully understood, but the most investigated element leading to the chorioretinopathy is the exposure to abnormal cortisol levels [2-5]. Another highly investigated risk factor for the aetiology of multifocal central serous chorioretinopathy is the exposure to significant stress Correspondence to: Assoc. Prof. Cristina Stan, Department of Ophthalmology, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, 3-5 Clinicilor Street, Code: 400006, Cluj-Napoca, Romania Mobile phone: +40745 617 453, E-mail: cristrif1959@yahoo.com DOI:10.22336/rjo.2022.67