A Case of Dengue Fever with Macular Involvement

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.