Dengue retinochoroiditis

Abstract

Dengue is a mosquito-borne infection caused by a flavivirus. I describe the ocular findings observed in two patients infected with dengue virus who presented with acute onset of loss of vision preceded by febrile illness, malaise, generalized fatigue headache, and maculopapular rash. Ophthalmologic evaluation in each patient revealed a normal anterior segment. Vitreous cells were noted in one patient. Ophthalmoscopy revealed multiple foci of retinochoroiditis, vasculitis, cotton-wool spots, and retinal hemorrhages. The healing of the lesion showed discrete atrophic and pigmented retinochoroiditic scars. Fluorescein angiography displayed early hypofluorescence and late hyperfluorescence suggestive of leakage. The healed scars showed late staining. The serologic testing showed elevated IgG antibodies, and one had high IgM antibodies to dengue virus. Ocular findings of dengue fever consist of multifocal areas of retinochoroiditis and may lead to loss of vision. In Saudi Arabia, dengue fever should be considered in the differential diagnosis of multifocal chorioretinal lesions and retinal vasculitis.

Figure 1a

A 32-year-old male with history of blurring of vision in both eyes one week following febrile illness showing multifocal areas of retinochoroiditis, with cotton-wool spots and retinal hemorrhages in the right eye.

Figure 1b

The left eye of the patient in Figure 1 showing areas of active retinochoroiditis.

Figure 2a

A 43-year-old male with multifocal nummular pigmented retinochoroiditic scars in the right eye. Photo taken four months after onset of dengue fever.

Figure 2b

The left eye of patient in Figure 3 showing multifocal retinochoroiditic scars taken four months after onset of dengue fever.