Chorioretinal lesions in nonfatal cases of West Nile virus infection

doi:10.1016/S0161-6420(03)00720-6

Ophthalmology

Volume 110, Issue 9, September 2003, Pages 1732-1736

https://doi.org/10.1016/S0161-6420(03)00720-6 Get rights and content

Abstract

Objective

West Nile virus (WNV) disease is a zoonotic infection with recent outbreaks in the United States. Recent reports have highlighted the intraocular findings associated with WNV disease. We describe the intraocular findings observed in two patients infected by the West Nile virus.

Design

Observational case reports.

Methods

During an outbreak of WNV disease in Southwest Ohio, two patients with an acute onset of a systemic febrile illness accompanied by myalgia, arthralgia, headache, and a maculopapular rash were referred for blurred vision. Complete ophthalmologic examination, fundus photographs, and fluorescein angiograms were obtained on both patients. Both patients underwent serologic testing for viruses and cultures for bacteria, viruses, and fungi.

Results

Ophthalmologic examination in each patient revealed anterior segment and vitreous inflammatory cells and multiple partially atrophic and partially pigmented chorioretinal lesions clustered in the peripheral fundus. Fundus examination in case 2 also revealed mild disc edema in both eyes. Intracranial pressure as measured by lumbar puncture was borderline elevated. The chorioretinal lesions in both patients showed a striking similarity and appeared hypofluorescent centrally and hyperfluorescent around the edges on a fluorescein angiogram. Serologic testing for the WNV was positive in both patients, and tests for all other bacteria, fungi, and viruses were negative.

Conclusions

WNV usually causes mild symptoms, but it occasionally causes neurologic illness with fatal outcome or severe morbidity. We present the cases of two patients with serology-proven WNV disease who developed chorioretinal lesions with a targetlike appearance and iridocyclitis.

Section snippets

Case 1

A 61-year-old woman reported a 2-day history of severe headaches associated with chills, fever to 103° Fahrenheit, anorexia, profound generalized weakness, and difficulty with fine motor coordination. One week after the onset of symptoms, she developed a maculopapular rash involving the skin of both lower extremities. She also complained of blurred vision in both eyes without flashes, floaters, pain, or redness in either eye. Ophthalmologic examination 11 days after the onset of systemic

Discussion

Recent reports have highlighted a multifocal chorioretinitis seen in patients with WNV disease.5, 6, 7 These reports show a striking similarity in both the funduscopic and angiographic appearance of the chorioretinal lesions. In addition, our review of literature has revealed a single patient with WNV meningoencephalitis who developed optic disc edema, extraocular muscle paresis, and nystagmus.8 Cerebrospinal fluid opening pressure was not reported, hence it is unclear whether the optic disc

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M.J. Turell et al.
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Ann N Y Acad Sci
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There are more references available in the full text version of this article.

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Citation Excerpt :
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Manuscript no. 230105.

Supported in part by a Departmental Challenge Grant from Research to Prevent Blindness, Inc., New York, New York, to the Department of Ophthalmology, University of Cincinnati College of Medicine.

The authors have no financial interest in any product, drug, instrument, or piece of equipment discussed in the manuscript.

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Original articleChorioretinal lesions in nonfatal cases of West Nile virus infection☆

Abstract

Objective

Design

Methods

Results

Conclusions

Section snippets

Case 1

Discussion

West Nile virusa primer for the clinician

Ann Intern Med

West Nile fever—a reemerging mosquito-borne viral disease in Europe

Emerg Infect Dis

Nile virus activity—United States, 2001

MMWR Morb Mortal Wkly Rep

Potential North American vectors of West Nile virus

Ann N Y Acad Sci

Original article
Chorioretinal lesions in nonfatal cases of West Nile virus infection☆