Case Report: Foveolitis as an Indicator of Underlying Undiagnosed Dengue Fever

Abstract

We describe a case of dengue fever-associated foveolitis that presented initially to the ophthalmologists with complaints of unilateral diminution of vision. A 30-year-old Indian woman had presented with sudden onset diminution of vision in the left eye (LE) for the past 2 days. It was also associated with low-grade fever and myalgia, which started few days before visual deterioration. Fundus showed few retinal hemorrhages and tiny subretinal yellowish lesions at the fovea in the LE. Optical coherence tomography and fluorescein angiography were indicative of foveolitis. Amsler charting showed a central scotoma in the LE. She was treated with oral steroids along with supportive treatments. A near-complete anatomical and functional recovery was noted. Our case depicts the significance of awareness of the ophthalmic complications of dengue fever among both ophthalmologists and physicians, and also highlights the key clinical and multimodal imaging findings in a case of dengue foveolitis.

Figure 1.

Fundus images of the patient. (A) Normal right eye fundus. (B) Left eye fundus revealing superficial retinal hemorrhages (black arrow) and ill-defined tiny yellowish subretinal lesions at the center of the posterior pole (yellow arrow). This figure appears in color at www.ajtmh.org.

Figure 2.

Ancillary ophthalmic imaging on presentation. (A) Normal fundus fluorescein angiography (FFA) of the right eye (RE). (B) Late phase FFA of the left eye (LE) revealing perifoveal capillary leakages (yellow dotted circle) and few blocked fluorescence corresponding to the areas of retinal hemorrhages. (C) Spectral domain optical coherence tomography (SDOCT) showing normal foveal contour in the RE. (D) Spectral domain optical coherence tomography of the LE showed focal discontinuity in the ellipsoid zone and the external limiting membrane just above the intact retinal pigment epithelium (area within red bracket). A subfoveal hyperreflective lesion with conical elevation (white arrow) and few tiny parafoveal intraretinal cystoid spaces (yellow arrow) was also noticed. This figure appears in color at www.ajtmh.org.

Figure 3.

Repeat imaging of the left eye (LE) 2 weeks after initiation of treatment. (A) Fundus image showed partial resolution of the foveal lesions and hemorrhages. (B) Spectral-domain optical coherence tomography of the LE through the macula showed a residual localized linear hyperreflective lesion in the outer nuclear layer (yellow arrow) with restoration of the continuity of the ellipsoid zone and external limiting membrane. This figure appears in color at www.ajtmh.org.

Figure 4.

Fundus images after 3 months of initial presentation. (A) Right eye (RE) having normal appearance. (B) Left eye (LE) fundus almost normal, except very few punctate residual retinal hemorrhages. (C and D) Optical coherence tomography of the RE and LE, respectively, at 3 months showing normal foveal contour and retinal layers. This figure appears in color at www.ajtmh.org.