Systemic and Ophthalmic Manifestations of West Nile Virus Infection

Yos Priestley; Marcia Thiel; Steven B. Koevary

Disclosures

Expert Rev Ophthalmol. 2008;3(3):279-292. 

In This Article

Anterior Uveitis

Like vitritis, anterior uveitis is commonly seen along with chorioretinal lesions in patients with WNV. Often it is seen transiently early in the acute stage of ocular symptoms, which accounts for why it is easily missed.[60] Treatment of the uveitis involves the use of topical anti-inflammatory drugs and, such as other WNV ocular manifestations, is generally self limited.[29,60,61,62] The following are two cases of anterior uveitis that were reported in patients with confirmed WNV infection - first, a typical case of uveitis associated with chorioretinal lesions[60] and, second, an unusual case of uveitis in the absence of chorioretinal lesions.[71]

Case 1

In a case reported by Chan et al., a 71-year-old patient presented in the emergency room (ER) with a history of fatigue, joint pain, diarrhea, malaise, confusion and fever for the previous 10 days.[60] 1 month after presenting to the ER with symptoms of WNV infection, the patient complained of blurry vision and floaters greater in OD than OS. Her visual acuity was 20/40 OD and 20/30 OS. An examination of the anterior segment revealed mild cells in the anterior chambers of both eyes. Posterior segment evaluation showed moderate vitreous cells in the left eye. In addition, chorioretinal lesions were observed OU. Even though the patient was treated with topical prednisolone acetate, the vision in her left eye worsened a few weeks later to 20/200. Examination revealed normal anterior segments except for the presence of resolving cells in the anterior chambers. Examination of the left eye's fundus revealed arterial narrowing, perivascular sheathing, and vascular occlusion consistent with retinal vasculitis. The dosage frequency of topical prednisolone acetate was increased and the patient was started on oral prednisolone treatment. At her most recently reported follow-up examination, her visual acuity had improved to 20/25 OD and 20/70 OS. Her reduced OS vision was thought to be most likely due to ischemia due to retinal vasculitis and vascular occlusion.[60]

Case 2

In an interesting case presented by Kuchtey et al.,[71] a 56-year-old woman with history of hypertension, coronary artery disease, Graves disease, Type 1 diabetes, hepatic and pancreatic insufficiency, seizure disorder, and mitochondrial myopathy, presented with blurry vision, floaters, nausea, malaise and myalgias. She had been bitten by mosquitoes 3 weeks prior to the development of these symptoms. Upon examination, her visual acuity was 20/25 OD and 20/40 OS and she displayed bilateral nongranulomatous anient. She was treated with 1% prednisolone acetate hourly for 1 week and her visual acuity improved to baseline. After 3 weeks, her uveitis and systemic symptoms resolved.[71]

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