Retinal Vasculitis with Macular Infarction: A Dengue-related Ophthalmic Complication

Abstract

Introduction: Dengue-associated ocular complications are increasing owing to the rising global burden of dengue fever. We intend to highlight a rare and sight-threatening complication of this disease.

Case details: A 44-year-old male, with prior history of dengue fever, presented with diminution of vision in both eyes for 10 days. At presentation, his best-corrected visual acuity was 1/60 in the right eye and 6/18 in the left eye. Anterior segment findings were unremarkable. Fundus examination revealed vitritis, perivascular exudates, intraretinal hemorrhages, macular edema, peripapillary retinal whitening and cotton wool spots in both eyes suggestive of vasculitis, with additional retinal whitening affecting the right macula. Fundus fluorescein angiography revealed disc and perivascular leakage limited to posterior pole along with patches of blocked fluorescence. In addition, there was capillary nonperfusion due to occlusion of multiple small arterioles supplying the macula of right eye confirming macular ischemia. Macular edema with subretinal fluid in both eyes was evident on optical coherence tomography. Treatment was attempted with intravenous methylprednisolone which was futile even after three days of administration.

Conclusion: We report a case of retinal vasculitis with macular infarction attributed to dengue fever. Although uncommon, dengue-associated ocular complications can lead to irreversible visual loss. Therefore, clinicians should keep this disease entity in mind while evaluating febrile patients with visual complaints in dengue endemic regions.

Keywords: dengue fever; macular infarction; retinal artery occlusion; thrombocytopenia; vasculitis.

Figure 1

Clinical fundus photo of a 44-year-old male presenting with diminution of vision following dengue fever. (A) Right eye. (B) Left eye. Both eyes depicting perivascular exudates, intraretinal hemorrhages, cotton wool spots and macular edema. (A) Right eye showing additional retinal whitening exclusively inferior to the right macula.

Figure 2

Fundus fluorescein angiography of a 44-year-old male presenting with diminution of vision following dengue fever. (A) Right eye. (B) Left eye. Both eye showing disc and perivascular leakage limited to posterior pole indicative of vasculitis. In addition, there is capillary nonperfusion due to occlusion of multiple small arterioles supplying the macula of right eye confirming macular ischemia.