A 62-year-old woman reported multiple episodes of blurred vision in both eyes over the last 13 years, with subsequent complete recovery of visual acuity. The various outbreaks were treated with oral corticotherapy, which was discontinued after the respective remissions. She was diagnosed with serpiginous choroiditis based on clinical and angiographic findings.
Her family history includes a twin sister of her mother with a similar condition. She has no personal history of interest.
At the last ophthalmological examination, the disease remained inactive and visual acuity (VA) was unity in both eyes despite significant chorioretinal atrophy and scarring in the posterior pole, including the macula. The anterior segment showed no relevant findings and intraocular pressure was 14 mmHg in both eyes.
The fundus showed multiple geographically shaped cicatricial lesions, with atrophy and variable hypertrophy of the RPE throughout the posterior pole.

Fluorescein angiography showed multiple mottled lesions due to atrophy and hyperpigmentation, with late stage staining.

Four months earlier, she had begun to suffer from flatulent dyspepsia, vomiting and pruritus. Laboratory tests showed an increase in transaminases (GOT 110 and GPT 90), GGT (gamma-glutamyltranspeptidase) 110, hypergamma-globulinaemia (IgG 1620), ANA (antinuclear antibodies) 1/320, negative AMA (antimitochondrial antibodies).
HBV surface antigen, anti-HBs antibody, anti-HBc antibody and anti-HCV antibody were negative. A liver ultrasound was performed and was normal.
The picture had a good response to calculolytic bile acids. The suspected diagnosis was autoimmune hepatitis. It was decided not to perform aggressive diagnostic tests such as a liver biopsy due to the mild activity of the digestive symptoms.