J Korean Ophthalmol Soc.  2010 Apr;51(4):626-630. 10.3341/jkos.2010.51.4.626.

A Case of Bilateral Retinal Hemorrhages Caused by Plasmodium Vivax Malaria

• Choy YJ
• Park JS

• KMID: 2213410
• DOI: http://doi.org/10.3341/jkos.2010.51.4.626

Abstract

PURPOSE
To report a case of bilateral retinal hemorrhages caused by Plasmodium vivax malaria.
CASE SUMMARY
The 38-year-old male patient with cyclic high fever for 48 hours was admitted to the department of internal medicine in our hospital. He complained of decreased visual acuity of the left eye. The best corrected visual acuity was 1.0 in right eye and 0.3 in left eye. His blood hemoglobin concentration was 7.5 g/dl. Fundus examination revealed retinal hemorrhages in the posterior pole and preretinal hemorrhage in the macular area in his left eye. The peripheral blood smear confirmed Plasmodium vivax malaria. Hydroxychloroquine and Premaquine were given orally. Forty-nine days after the initial visit, retinal hemorrhages in the posterior pole and preretinal hemorrhage in the macula area occurred in his right eye. Although retinal hemorrhages in both eyes were reduced 100 days after the initial visit, the best corrected visual acuity was 0.2 in right eye and 0.4 in left eye and visual acuity did not improve.
CONCLUSIONS
Retinal hemorrhages infrequently can occur by Plasmodium viviax malaria and can result in permanent visual loss.

Keyword

Plasmodium vivax; Retinal hemorrhages

MeSH Terms

Adult
Eye
Fever
Hemoglobins
Hemorrhage
Humans
Hydroxychloroquine
Internal Medicine
Malaria
Malaria, Vivax
Male
Plasmodium
Plasmodium vivax
Retinal Hemorrhage
Retinaldehyde
Visual Acuity
Hemoglobins
Hydroxychloroquine
Retinaldehyde

Figure

• 

  Figure 1. The fundus photographs of a 38-years-old male infected with Plasmodium vivax at presentation. (A) The fundus of the right eye shows normal posterior retina. (B) The fundus of the left eye shows the multiple retinal hemorrhages in the posterior pole and preretinal hemorrhage in the macular area.

• 

  Figure 2. The peripheral blood smear finding at admission shows Plasmodium vivax schizont (black arrow), gametocyte (white arrow) and ring form trophozoite (arrow head) (Wright stain, ×400). Note that red blood cells hosting the schizont and the gametocyte are larger than the surrounding non-parasitized red blood cells.

• 

  Figure 3. The fundus photograph, fluorescein angiograph, and optical coherence tomography (OCT) of the patient infected by Plasmodium vivax at 49 days after initial visit. (A), (B) The fundus of both eyes shows the multiple retinal hemorrhages in the posterior pole and preretinal hemorrhage in the macula area of the right eye. The retinal hemorrhages of the left eye increased. (C), (D) Fluorescein angiography shows blocked fluorescence due to the multiple retinal hemorrhages in the posterior pole and preretinal hemorrhage in the macula area. (E), (F) Central macular thickness are 358 μm in the right eye and 239 μm in the left eye. Segmentation error is noted in the OCT of the right eye due to preretinal hemorrhages at the fovea.

Reference

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