A 35-year-old woman came to our hospital on November 22, 2010, after the onset of unilateral blurred vision and scotomata, purpuric rash over bilateral lower limbs, and metrorrhagia for four days. She had visited Vietnam for 11 days and fever, chills, and headache subsequently developed one day after returning to Japan. Fever and headache subsided six days after onset of disease.
Laboratory data showed a platelet count of 109,000 cells/μL, dengue virus nonstructural protein 1, and IgM against dengue virus 10 days after onset of disease. Visual acuity was reduced to 20/25 in the left eye. Humphrey visual field testing showed nonspecific visual field defects. Funduscopic examination showed retinal hemorrhages and white spots (Figure 1). She was observed without treatment.
Figure 1.
Fundus photographs of right eye (A) and left eye (B) of a 35-year-old woman at initial examination (10 days after onset of disease), showing several retinal hemorrhages and white spots. Optical coherence tomography showed non-specific findings (C = right eye; D = left eye).
Blurring of vision and scotomata typically coincides with thrombocytopenia and clinical features include blot hemorrhages.1,2 Visual recovery usually corresponds with improving platelets levels, however, scotomata may persist for several weeks in some cases despite the resolution of ocular signs.1 The patient described small scotomata 19 days after onset of disease despite the resolution of thrombocytopenia and hemorrhagic spots (Figure 2). Her visual symptoms improved and visual acuity improved to 20/17 at 84 days after onset of disease.
Figure 2.
Fundus photographs of both eyes (A, C, and E = right eye; B, D, and F = left eye) of a 35-year-old woman 12 days after onset of disease (A and B), 19 days after onset of disease (C and D), and 84 days after onset of disease (E and F), showing gradual improvement and disappearance of retinal hemorrhages and white spots. The patient's platelet count was within the reference range 12 days after onset of disease (186,000 cells/μL) and 84 days after onset of disease (175,000 cells/μL).
Footnotes
Financial support: This study was supported in part as project “Research on Emerging and Re-emerging Infectious Diseases” by the Ministry of Health, Labor and Welfare, Japan (H23-Shinkou-Ippan-010).
Disclosure: None of the authors have any conflicts of interest.
Authors' addresses: Mugen Ujiie, Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan, E-mail: infinite_u@hotmail.com. Meng Ling Moi, Department of Virology 1, National Institute of Infectious Diseases, Toyama 1-23-1, Shinjuku, Tokyo 162-8640, Japan, E-mail: sherry@nih.go.jp. Norio Takeda, Department of Ophthalmology, National Center for Global Health and Medicine, Tokyo, Japan, E-mail: ntakeda@hosp.ncgm.go.jp.
References
- 1.Chan DP, Teoh SC, Tan CS, Nah GK, Rajagopalan R, Prabhakaragupta MK, Chee CK, Lim TH, Goh KY. Ophthalmic complications of dengue. Emerg Infect Dis. 2006;12:285–289. doi: 10.3201/eid1202.050274. Eye Institute Dengue-Related Ophthalmic Complications Workgroup, Dengue Maculopathy Study Group. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Lim WK, Mathur R, Koh A, Yeoh R, Chee SP. Ocular manifestation of dengue fever. Ophthalmology. 2004;111:2057–2064. doi: 10.1016/j.ophtha.2004.03.038. [DOI] [PubMed] [Google Scholar]