An unusual case of unilateral chorioretinitis and blind spot enlargement associated with asymptomatic West Nile virus infection

Sanz, G. González; Rodríguez, Edgar De Jesus; Vila-Delgado, Mariam; Oliver, Armando L.

doi:10.1016/j.ajoc.2020.100723

Cited by 5 publications

(5 citation statements)

References 11 publications

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“…Hasbun et al 2016 reported only one case of retinal involvement in 26 cases of asymptomatic WNV infection [6]. In addition, Sanz et al 2020 showed one case of unilateral chorioretinitis secondary to WNV infection in an asymptomatic patient with an eighteen-month history of photopsia and visual disturbances in her left eye [7]. Multifocal chorioretinitis is the most frequent ocular manifestation of WNV infection.…”

Section: Discussionmentioning

confidence: 99%

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Bilateral multifocal chorioretinitis as the only presentation of acute West Nile virus infection: a case report

Valsecchi,

Veronese,

Roda

et al. 2024

BMC Ophthalmol

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Background To describe a case of bilateral multifocal chorioretinitis as the only presentation of acute West Nile virus (WNV) infection in the absence of neurological involvement. Case presentation A 78-year-old Italian woman was admitted to our emergency department because she noticed blurry vision in both eyes. She did not report fever, fatigue, or neurological symptoms in the last few days. Multimodal imaging showed the presence of bilateral hyperfluorescent lesions with a linear distribution, that corresponded to hypocyanescent spots on indocyanine green angiography. Antibody serology showed the presence of IgM antibodies, IgG antibodies, and ribonucleic acid (RNA) for WNV. Magnetic resonance imaging (MRI) of the brain ruled out central nervous system involvement. Three months later, the patient reported spontaneous resolution of her symptoms and remission of the chorioretinal infiltrates. Conclusions In endemic areas, it is important to think of acute WNV infection as an explanatory etiology in cases of multifocal chorioretinitis, even without neurological involvement.

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Section: Discussionmentioning

confidence: 99%

“…Multifocal chorioretinitis is a common ocular manifestation of WNV infection with neuroinvasive disease, which is frequently asymptomatic and self-limiting [4] However, involvement of the choroid and retina is rare in patients with asymptomatic systemic disease [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Bilateral multifocal chorioretinitis as the only presentation of acute West Nile virus infection: a case report

Valsecchi,

Veronese,

Roda

et al. 2024

BMC Ophthalmol

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“…These findings occur mainly due to blind spot enlargement causing the displacement of the peripapillary retina and refractive changes due to significant optic nerve head swelling. Other common causes of blind spot enlargement are inflammatory or infectious diseases such as syphilis,[ 3 ] West Nile virus,[ 4 ] or rubella vaccination. [ 5 ] In these cases, blind spot enlargement corresponds to retinal and choroidal areas that appear abnormal in the fundus examination.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding the treatment of these diseases, the use of steroids remains a debate among uveitis specialists. [ 4 ] Finally, in most cases, symptoms of MEWDS and AIBSE are reversible without treatment after weeks or months.…”

Section: Discussionmentioning

confidence: 99%

Blind spot enlargement: A differential diagnosis challenge

Tsiogka

Karamaounas²,

Sideri³

et al. 2023

Saudi J Ophthalmol

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A 39-year-old woman, without any systemic or ocular history, presented with a paracentral scotoma in her right eye with normal visual acuity. Humphrey's visual fields showed a reversible enlargement of the right blind spot. The final diagnosis was acute idiopathic blind spot enlargement which was successfully treated with intravenous steroids. Although differential diagnosis of blind spot enlargement can be challenging, multimodal imaging with combination of visual field's assessment can help us make the right diagnosis.

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“…Specific ophthalmic treatments may be necessary to address intraocular inflammation or posterior segment complications. These treatments include topical steroids for anterior uveitis, peripheral retinal photocoagulation for neovascularization resulting from occlusive vasculitis, pars plana vitrectomy for non-clearing vitreous hemorrhage or tractional retinal detachment, and intravitreal injection of anti-vascular endothelial growth factor agents for choroidal neovascularization or associated macular edema in cases of chorioretinitis [88][89][90]. The benefit of systemic steroids is not evidence-based, but the positive role in recovery could justify their use in cases of severe posterior segment involvement.…”

Section: Treatment and Prognosismentioning

confidence: 99%

Ocular Manifestations of Flavivirus Infections

Zina,

Hoarau,

Labetoulle

et al. 2023

Pathogens

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Flaviviruses are a group of positive-sense, single-stranded RNA viruses predominantly transmitted by arthropods (mainly mosquitoes) that cause severe endemic infections and epidemics on a global scale. They represent a major cause of systemic morbidity and death and are expanding worldwide. Among this group, dengue fever, the West Nile virus, yellow fever, Japanese Encephalitis, and, recently, the Zika virus have been linked to a spectrum of ocular manifestations. These manifestations encompass subconjunctival hemorrhages and conjunctivitis, anterior and posterior uveitis (inclusive of vitritis, chorioretinitis, and retinal vasculitis), maculopathy, retinal hemorrhages, and optic neuritis. Clinical diagnosis of these infectious diseases is primarily based on epidemiological data, history, systemic symptoms and signs, and the pattern of ocular involvement. Diagnosis confirmation relies on laboratory testing, including RT-PCR and serological testing. Ocular involvement typically follows a self-limited course but can result in irreversible visual impairment. Effective treatments of flavivirus infections are currently unavailable. Prevention remains the mainstay for arthropod vector and zoonotic disease control. Effective vaccines are available only for the yellow fever virus, dengue virus, and Japanese Encephalitis virus. This review comprehensively summarizes the current knowledge regarding the ophthalmic manifestations of the foremost flavivirus-associated human diseases.

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An unusual case of unilateral chorioretinitis and blind spot enlargement associated with asymptomatic West Nile virus infection

Cited by 5 publications

References 11 publications

Bilateral multifocal chorioretinitis as the only presentation of acute West Nile virus infection: a case report

Bilateral multifocal chorioretinitis as the only presentation of acute West Nile virus infection: a case report

Blind spot enlargement: A differential diagnosis challenge

Ocular Manifestations of Flavivirus Infections

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