Paraneoplastic Acute Exudative Polymorphous Vitelliform Maculopathy Associated with Early Gastric Carcinoma

PURPOSE: To describe a case of presumed paraneoplastic acute exudative polymorphous vitelliform maculopathy (AEPVM) associated with early gastric carcinoma with subsequent slow regression of vitelliform lesions followed by localized outer retinal atrophy. METHODS: a 58-year-old woman with a remote history of central serous chorioretinopathy presented with new metamorphopsia and multifocal subretinal yellowish deposits. Multimodal imaging-including spectral-domain optical coherence tomography (SD-OCT), fundus autofluorescence (FAF), fluorescein angiography-was performed at baseline. Genetic and serologic testing as well as systemic evaluation with total-body MRI and endoscopy were conducted to exclude inherited or inflammatory causes and to identify a possible paraneoplastic association. RESULTS: At presentation OCT revealed shallow serous detachments with hyperreflective subretinal material consistent with multifocal vitelliform lesions. At seven months, partial regression of lesions was noted, leading to systemic evaluation that uncovered an early intramucosal gastric adenocarcinoma, successfully treated by endoscopic submucosal dissection alone. Over seven years multimodal imaging demonstrated near-complete resorption of vitelliform material and the development of a localized zone of retinal pigment epithelium and outer retinal atrophy along the superior arcade. Best-corrected visual acuity remained 20/20 throughout. No ocular or systemic immunosuppressive therapy was administered. CONCLUSION: AEPVM may be associated with early gastric carcinoma and spontaneous regression of vitelliform lesions evolving into localized atrophy without visual decline. Long-term follow-up is essential given the late progression to atrophy.