OBJECTIVE To report multimodal imaging in patients with serpiginous choroiditis. METHODS A 60-year-old woman with active serpiginous choroiditis in the right eye was evaluated during the disease course with multimodal imaging, which included fluorescein angiography, swept-source optical coherence tomography (SS-OCT), OCT angiography, fundus autofluorescence (FAF), and retromode imaging. RESULTS The patient had subretinal, yellowish lesion on the macula at presentation. The margin of the lesion was remarkable in FAF and retromode imaging. SS-OCT scans revealed slightly thickened hyporeflective space and tiny hyperreflective spots at the choriocapillaris level. OCT angiography demonstrated decreased vascularity on the choriocapillaris. Although the area was partially replaced with irregular capillaris, the photoreceptor defect persisted following systemic corticosteroid therapy. CONCLUSIONS Multimodal imaging shows that inflammation of the choriocapillaris is a main pathology of serpiginous choroiditis. The destruction of the choriocapillaris may lead to the photoreceptor disruption, resulting in permanent visual loss in serpiginous choroiditis.