Dengue Fever-Associated Maculopathy and Panuveitis in Australia

Abstract

Purpose. To describe a case of dengue fever-associated maculopathy and panuveitis to raise awareness of these ophthalmic complications of dengue in Australia in the light of recent increasing numbers of outbreaks from equatorial through to tropical Australia. Case Report. A 37-year-old Caucasian Australian male returning from Cambodia presented with a bilateral dengue fever-associated maculopathy with left panuveitis diagnosed clinically and haematologically. Automated perimetry revealed bilateral paracentral scotomas while optical coherence tomography demonstrated the maculopathies to be of the diffuse retinal thickening type in the right eye and acute macular neuroretinopathy (AMN) type in the left eye. He was treated conservatively with only topical steroids and cycloplegia and made a full clinical visual recovery. Conclusion. Our case study underscores the importance of the awareness of the ophthalmic complications of dengue fever as despite their rarity they can be potentially sight threatening. The incidence of these complications is likely to rise in Australia with increased global warming and the distribution of Aedes aegypti into subtropical Australia.

Acute macular neuroretinopathy in dengue virus serotype 1

“…Ooi et al 14 described an adult male with hematologically confirmed dengue fever who presented with paracentral scotomas OU that fully resolved after topical treatment with steroids and cycloplegia. SD-OCT of AMN is characterized by hyperreflective lesions of the outer retinal layers during the acute phase.…”

Dengue Virus Infection of Human Retinal Müller Glial Cells

“…Retinopathy associated with DENV often presents with signs of posterior-segment inflammation, and the spectrum of disease includes vasculitis and retinitis [ 65 ]. Macular oedema, a prominent feature of dengue retinopathy [ 6 , 8 , 10 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 ], represents breakdown of the BRB [ 76 ]. Müller cells perform an important role in controlling retinal fluid homeostasis [ 16 ], and direct infection of the cells could impair their function in this critical process, leading to excess fluid in the retinal interstitium with consequent macular oedema.…”

Severe ocular and adnexal complications in dengue hemorrhagic fever

“…Existing literature about ophthalmic complications secondary to dengue describes uveitis, retinitis, sub-hyaloid hemorrhage, retinal hemorrhage maculopathy, neuororetinitis, panophthalmitis, and optic neuropathy. [ 8 9 10 11 12 13 14 15 16 ] Anecdotal reports of corneal epitheliopathy exist. [ 17 ] With medical management, good visual recovery has been documented, and vision loss is considered rare.…”

“…[ 1 2 3 4 5 6 7 8 ] Ophthalmic complications have earlier been known to occur in the form of anterior uveitis, panuveitis, retinitis, sub-hyaloid hemorrhage, retinal hemorrhages, maculopathy, neuororetinitis, optic neuropathy, and corneal epitheliopathy. [ 9 10 11 12 13 14 15 16 17 18 ] Notably, over the past decade, the disease has manifested in a severe form of ocular and orbital involvement with the scleral melt, necrotizing scleritis, globe rupture, endophthalmitis, and panophthalmitis. [ 19 20 21 22 23 24 25 26 27 ] However, the existing literature is limited to the case report and short case series.…”