History of Present Illness
A 25 yo male presented with painless blurring of vision OU for 2 days. One month prior he presented with adult respiratory distress syndrome (RDS) and thrombocytopenia diagnosed as dengue fever for which he was hospitalized and symptomatic treatment was given.
Ocular Examination
Questions Asked
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Did he have any visual acuity (VA) problems at the time of diagnosis of dengue fever?
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No.
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What symptoms of dengue fever did he have on presentation, and how was his RDS managed?
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He presented with fever, skin rashes, and difficulty in breathing for which he was hospitalized.
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How did he catch the disease—namely, was there any activity he was participating in that would have increased his likelihood of having the disease?
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No.
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How was dengue fever diagnosed?
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Dengue fever was diagnosed based on positive serology.
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Assessment
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Infectious multifocal retinitis both eyes (OU) with macular edema, left eye (OS).
Differential Diagnosis
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Chikungunya
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Cytomegalovirus (CMV) retinitis
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Acute leukemia
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Human immunodeficiency virus (HIV)
Working Diagnosis
Dengue retinopathy and associated panuveitis, OU, with macular edema OS
Testing
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Complete blood count (CBC): normal
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Serology
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Positive: dengue immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies
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Negative: HIV I/II and Chikungunya
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Chest x-ray: normal
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Mantoux test: negative
Fundus Fluorescein Angiography
Figs. 68.3 and 68.4 showed early hypofluorescence and late hyperfluorescence of chorioretinal lesions with disc leakage and diffuse perivascular leakage.
