Birdshot Retinochoroidopathy, usually abbreviated BSRC, is a rare autoimmune disease of the retina. It is most common in women over the age of 50, but can occur in males or in younger people as well (though this is exceedingly uncommon). It manifests as idiopathic posterior uveitis, which causes pain, distorted vision and sometimes motion sickness. It is hereditary and genetic, being linked to the H26 gene, though not all people positive for the gene develop the disease.

Diagnosis is difficult, and usually involves ruling out other causes such as lupus, sarcoidosis, cancer, injury and radiation damage. There is a characteristic pattern of lesions on the retina which resembles a spread of bird shot, from which the disease takes its name, though this pattern can form from other diseases, especially sarcoidosis. Treatment is typically palliative, aiming for symptomatic relief, and consists of prednisone or dexamethasone to mitigate the inflammation, ibuprofen for pain and meclizine or similar for vertigo and motion sickness (though compazine or ondansetron may also be used). In severe cases, which is actually most of them, immunosupressant therapies may be used.

Cyclosporine and mycophenolate are the first-line immunomodulators, though methotrexate, tacrolimus and 6-mercaptopurine are also used. In cases where even these drugs are of little avail, the anti-cancer agents azathioprine (Imuran) and cyclophosphamide (Cytoxan) may be used, though they are associated with severe side effects including vomiting, hair loss, bladder damage and secondary malignancy. Other drugs being experimented with for BSRC are Remicade and Zenapax, which are antibody-based immunosupressants that inhibit tumor necrosis factor alpha. These drugs are better tolerated than most immunosupressants, but they carry a strongly elevated risk for tuberculosis, mycobacterium avium complex and, in places where it is prevalent, leprosy. Patients may be co-medicated with isoniazid, rifampicin or dapsone to prevent these diseases.

In 2002, my mother was diagnosed with BSRC at the age of 49 (younger than most who are diagnosed with it), though she has had symptoms for several years now. The above information comes from her doctor and from various internet sources in my quest to find information on this disease.

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