J Korean Ophthalmol Soc.  2014 Feb;55(2):317-323. 10.3341/jkos.2014.55.2.317.

A Case of Dengue Fever with Macular Involvement

• Jin KH
• Ahn JY
• Min JK
• Shin JH
• Moon SW

• KMID: 2218431
• DOI: http://doi.org/10.3341/jkos.2014.55.2.317

Abstract

PURPOSE
To report a case of Dengue fever with bilateral macular edema and retinitis.
CASE SUMMARY
A 31-year-old female was referred to our clinic with blurred vision. The patient had visited Bali, Indonesia approximately 2 weeks prior. Dengue fever was diagnosed at the Division of Infectious Disease because the patient's serum dengue virus antibodies test was positive for dengue viral IgM antibodies. The patient's best corrected visual acuity was 0.4 in the right eye and 0.6 in the left eye. Slit lamp examination showed inflammatory cells in the vitreous but not in the anterior segment of both eyes. Fundus examination showed thickening of the retina in both eyes as well as a splinter retinal hemorrhage in left eye. Fluorescein angiography revealed hyperfluorescence of the venule in the perifoveal vascular network of the left macula, and indocyanine green angiography showed early diffuse hyperfluorescence in both eyes. Standard automated perimetry showed an overall reduction of the visual field and an increase in scotoma in both eyes. At 1 week after the initial visit, the macular edema had not improved and the patient's vision had deteriorated, especially in left eye. To improve the macular edema and ocular inflammation, a subtenon triamcinolone acetonide injection in the left eye was administered. At 5 weeks after treatment, corrected visual acuity improved to 1.0 in both eyes. Ocular findings, such as macular edema and intraretinal hemorrhage were resolved. The patient did not complain of any remaining discomfort. However, standard automated perimetry revealed that a pericentral scotoma was still present in left eye.
CONCLUSIONS
In the present study, the authors report a case of bilateral macular edema and retinitis at the posterior pole after dengue infection. The patient demonstrated a relatively positive response to steroid therapy in the left eye and to conservative treatment in the right eye.

Keyword

Dengue fever; Macular edema; Retinitis

MeSH Terms

Adult
Angiography
Antibodies
Communicable Diseases
Dengue Virus
Dengue*
Female
Fluorescein Angiography
Hemorrhage
Humans
Immunoglobulin M
Indocyanine Green
Indonesia
Inflammation
Macular Edema
Retina
Retinal Hemorrhage
Retinitis
Scotoma
Triamcinolone Acetonide
Venules
Visual Acuity
Visual Field Tests
Visual Fields
Antibodies
Immunoglobulin M
Indocyanine Green
Triamcinolone Acetonide

Figure

• 

  Figure 1. (A, B) Fundus photography showed intraretinal white lesions along the venules and arterioles of the perifoveolar vascular network and thickening of the retina at the papillomacular bundle in both eyes and a splinter retinal hemorrhage in the left eye at patient’s first visit. (C, D) Six weeks after the first visit, white lesions, thickening of retina and a splinter hemorrhage and macular edema subsided.

• 

  Figure 2. (A, B) Fluorescein angiography (left column) revealed late hyperfluorescence of the arterioles of the macula in left eye. Indocyanine green angiography (right column) showed early diffuse hyperfluorescence in both eyes at patient’s first visit. The hypofluorescent spots (white arrows) which were corresponding to yellow retinal lesion on fundus photograph were noted. (C, D) Six weeks after the first visit, hyperfluorescence were resolved.

• 

  Figure 3. (A, B) Optical coherence tomography showed irreg-ular density of outer neurosensory retina at the fovea in left eye. Focal subretinal fluid and retinal edema mainly affecting maculopapular bundle were observed in both eyes at patient’s first visit. (C, D) Six weeks after the first visit, macular thickening and subretinal fluid were resolved.

• 

  Figure 4. (A, B) Humphrey visual fields show overall reduction of visual field and the increase of scotoma were observed in both eyes at patient’s first visit. (C, D) Six weeks after the first visit, peripheral visual field defects were improved in both eyes, but central scotoma remained in the left eye.

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  Figure 5. (A, B) Six weeks after the first visit, corrected visual acuity improved to 1.0 in the both eyes. But trace arrays of multifocal electroretinography show suppression of central lesion in the both eyes.

Reference

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