Granular Hyperreflective Specks by Spectral Domain Optical Coherence Tomography as Signs of West Nile Virus Infection: The Stardust Sign

Abstract

During West Nile virus infection, granular hyperreflective specks located predominantly within the outer and inner nuclear layers were visualized by spectral domain optical coherence tomography and may be a sign of West Nile virus infection.

Multimodal Imaging Findings in Acute West Nile Virus Chorioretinitis

“…Consistent with previous reports regarding the most common ocular manifestation of WNV infection, [3][4][5][6][7][8][9][10][11] this patient's course demonstrated the three previously described stages of WNV infection with unique imaging findings in the acute phase. Typical funduscopic findings of acute infection include deep, round, cream-colored lesions often in a linear or curvilinear distribution, [3][4][5][6][7][8][9][10][11] as seen in our case (Figure 1, A and B). Although the FA pattern in the acute phase that has been previously described is early hypofluorescence and late staining, 3-5 our patient's FA findings differed in the acute phase, demonstrating expanding pinpoint leakage throughout the study.…”

“…Consistent with previous reports regarding the most common ocular manifestation of WNV infection, 3–11 this patient's course demonstrated the three previously described stages of WNV infection with unique imaging findings in the acute phase. Typical funduscopic findings of acute infection include deep, round, cream-colored lesions often in a linear or curvilinear distribution, 3–11 as seen in our case (Figure 1, A and B).…”

“…Our patient's lesions were in the subacute stage at 1-month follow-up, consisting of partial pigmentation with a surrounding creamy halo. The patient's FA at the 2-month visit demonstrated the classically described target lesion: central hypofluorescence with peripheral hyperfluoresence [3][4][5][6][7][8][9][10][11] (Figure 3, D-F). This timing has not been well established in the literature.…”

“…The most common ocular manifestation of WNV infection is multifocal choroiditis, typically seen in the chronic phase. [3][4][5][6][7][8][9][10][11] Less common ocular manifestations, such as optic atrophy 3 and occlusive vasculitis, 3,5,12,13 may occur and result in poor visual outcomes. We report a case of WNV chorioretinitis with fluorescein angiography (FA), indocyanine green angiography (ICGA), and swept-source optical coherence tomography angiography (SS-OCTA) imaging findings in the acute phase of infection.…”

Superficial and Deep Macular Vessel Occlusion in West Nile Virus

“…2 b). Furthermore, the granular hyperreflective specks reported by Wang et al [7] could also be seen in the RE of our patient.…”