A Tourist From Thailand Loses Her Vision
Abstract & Commentary
Synopsis: An unusual manifestation of dengue fever serves as a warning about its potential ocular complications.
Source: Haritoglou C, et al. Lancet. 2002;360:1070.
A 25-year-old woman had been on holiday in Thailand during 2002. Two days before her return to Germany, she developed aching muscles and decreased visual acuity. She then went on to develop fever, maculopapular rash, hepatosplenomegaly, and thrombocytopenia (69, 000/mL). On ophthalmological examination visual acuity was reduced to 20/500, bilaterally. Evoked potential measurements were abnormal as well as color vision testing. Funduscopic examination revealed bilateral exudative maculopathy and small hemorrhages. Visual acuity eventually improved over 8 weeks to 20/100 in the right eye and 20/30 in the left eye. The reduction of vision in the right eye was due to intraretinal lipid deposits, presumably as sequelae of exudation initially observed. A serum IgM antibody titer of 1:640 confirmed dengue fever.
Comment by Michele Barry, MD
This is an unusual presentation for dengue fever in a traveler who had returned from Thailand. Although ocular manifestations of dengue fever have been described before, this case is a sober reminder that increased vascular permeability and breakdown of the inner retinal blood barrier can occur, even in nonhemorrhagic cases of dengue fever. Microinfarctions of the nerve fiber layer, as well as an optic neuritis, have been described in dengue fever. Of interest, the patient flew home in a pressurized plane where pressure inequities might have exacerbated exhudation from leaky capillaries in the eye. Although steroids are generally used in optic neuritis, this patient was not given steroids due to Haritoglou and colleagues’ discomfort in administrating steroids during dengue viremia—a controversial point. Usually, ocular alterations do resolve in dengue without specific treatment, but this tourist was left with impaired visual acuity in her right eye.
Dr. Barry is Professor of Medicine and Laboratory Medicine; Co-Director, Tropical Medicine and International Travelers' Clinic, Yale University School of Medicine.
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