Multimodal Imaging of West Nile Virus Chorioretinitis

Abstract

Multiple fundus imaging modalities used during the diagnosis of West Nile chorioretinitis are consistent with outer retinal and pigment epithelial changes, suggesting outer retina and retinal pigment epithelium as the primary sites of ocular involvement.

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

“…By SD-OCT, findings of deep retinal hyperreflective lesions extending from the outer nuclear layer to the retinal pigment epithelium were described, and the disruption of ellipsoid zone and outer retinal layers corresponded to patterns of visible yellow-white lesions found on funduscopic examination. 9 Similarly, the current case documented clinical correspondence of yellow-white lesions to areas of outer retinal and pigment epithelial hyperreflectance on SD-OCT, which disrupted the ellipsoid zone reported by Learned et al 9 (Figure 2). Additionally and previously unreported to our knowledge were observations of granular hyperreflective specks casting variably dense shadows located predominantly within the outer and inner nuclear layers.…”

“…First, the ophthalmic finding of yellow-white lesions correlated with ellipsoid zone disruption as previously reported ( Figure 2). 9 Second, a total of 111 prominent intraretinal granular hyperreflective specks were identified with 51% (n = 57/111) localizing to the outer nuclear layer, 6% (n = 7/105) to the outer plexiform layer, 26% (n = 29/111) to the inner nuclear layer, and 16% (n = 18/ 111) to the ganglion cell layer (Figure 1). Fluorescein angiography demonstrated multifocal circinate regions of outer retinal staining in the macula and midperiphery corresponding to the visible, outerretinal yellow-white lesions.…”

“…10,11 It is speculated that varying viral strains, different patient characteristics, and increasing awareness of WNV may all contribute to the variable severity of presentation between studies. 9 This report documents the retinal findings and progression of a visually symptomatic case of WNV meningoencephalitis over 14 weeks and documents unique spectral domain optical coherence tomography (SD-OCT) finding of granular hyperreflective specks located predominantly in the outer nuclear and inner nuclear layers.…”

“…4,[6][7][8] Ocular symptoms were first reported in 1956 and include decreased vision, photophobia, retrobulbar pain, diplopia, and floaters. 9 Ocular manifestations of WNV infection include chorioretinitis, uveitis, occlusive retina vasculitis, optic neuritis, and choroidal neovascularization. 10,11 It is speculated that varying viral strains, different patient characteristics, and increasing awareness of WNV may all contribute to the variable severity of presentation between studies.…”

Emerging Causes of Viral-associated Uveitis

“…More serious manifestations include meningitis, encephalitis, or meninoencephalitis. This occurs in 0.67–1% of those infected 5 . Treatment of systemic infection is typically supportive 6 .…”