Title

RETINAL INTRAOCULAR CHANGES ASSOCIATED WITH DENGUE: A CASE REPORT

Introduction

Dengue is an endemic disease in Brazil. There are rare ocular complications related to it, such as: dengue maculopathy; Roth spots; anterior uveitis; microvascular changes; retinal vasculitis; occlusion of the branch of the central retinal artery, and others.

Methods

Description of a clinical case of an immunodepressed patient with extensive retinal involvement - cotton wool spots, macular ischemia and retinal vasculitis, associated with dengue symptoms

Results

D.V.C.S., 47 years old, male, immunosuppressed due to kidney transplant in the past, medicated with tacrolimus. He came to the Retina outpatient clinic of the HOB with a complaint of low visual acuity in both eyes (BE). On the initial eye examination, in the visual acuity test the patient could count fingers on the examiner’s hand at a distance of two meters ahead in the right eye and 20/400 in the left eye; intraocular pressure 21mmHg in BE. First, Fundoscopy showed confluent cotton patches, microhemorrhages, retinal edema in the posterior pole. Second, Angiofluoresceinography revealed perivascular extravasation, extensive macular ischemia and areas of capillary non-perfusion. And third, the Macular optical coherence tomography exhibited reflectivity changes in the retinal layers, accumulation of subretinal fluid. Laboratory tests showed negative results for syphilis and toxoplasmosis, and also for serology for cytomegalovirus and herpes simplex IgG and non-reactive IgM, and for dengue serology for IgM reagent. Then ,the Purtscher-like hypothesis related to Dengue was suggested. So, in the last examination, 26 days after the first consultation, the patient made progress showing the maintenance of his VA in RE and improvement of VA in LE for 20/400. After all, fundscopy showed : a slightly pale optical disc, improvement in the aspect of arterial occlusion.

Discussion

Although ocular manifestations of dengue are rare, they can become more frequent, with the increased incidence of the disease and the co-circulation of multiple serotypes.

Keywords

Dengue Virus ; Retinal Edema; Retinopathy

Area

CLINICAL CASE

Authors

IRINEU RIBEIRO MELO JUNIOR, THAYS OLIVEIRA CARMO BORGES MELO, ISADORA FERRO NOGUEIRA, VICTORIA OLIVEIRA CARMO BORGES, Vanessa Mendonça Rocha, Vinicius Ferreira Kniggendorf, Sebastião Xavier Curado