Multifocal choroiditis and panuveitis presenting with progressive equatorial linear streaks: Evolution of schlaegel lines documented with multimodal imaging

Purpose: To describe the progressive, peripheral linear streaks of the equatorial retina, known as Schlaegel lines, in multifocal choroiditis and panuveitis (MCP). Methods: A case report of a 13-year-old girl with MCP showed progression of retinal linear streaks. Extensive systemic and ophthalmologic investigations were performed. Results: Linear streaks in MCP showed progression before the institution of immunomodulatory treatment. Infrared imaging showed hyperreflectivity of the lesions with surrounding hyporeflectivity. Optical coherence tomography showed elevated and irregular hyperreflectivity of the retinal pigment epithelium and choroidal hyperreflectivity. These findings, including the clinical progression before immunomodulatory therapy and negative systemic evaluation for infectious entities, are consistent with MCP. Conclusion: Patients with linear streaks in the setting of atypical MCP can progress and should be treated with adequate systemic corticosteroids and immunomodulatory agents. This case is unique in that it shows the evolution of Schlaegel lines using a multimodal imaging approach. Multimodal imaging can provide ancillary evidence of disease activity.