Bilateral Post-typhoid Retinitis: A Case Report

Anu Manandhar,Kumudini Subedi,Smita Shrestha

doi:10.3126/medphoenix.v6i1.34638

Anu Manandhar, Kumudini Subedi + Show 1 more

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https://doi.org/10.3126/medphoenix.v6i1.34638

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Abstract

Retinitis following typhoid fever is an immune-mediated reaction that is rarely reported in literature. We present a case of a 20-year-old pregnant female who presented with progressive loss of vision in both eyes for three weeks. She had completed treatment for enteric fever 4 weeks before. Presenting vision was 6/36 in right eye and 3/60 in left eye. Fundus examination showed retinitis with retinal haemorrhages and macular stars in both eyes. After approval from gynaecologist, oral steroid was given. Vision improved significantly to 6/6 in right eye and 6/12 in left eye after 1.5 months of treatment. There was resolution of haemorrhages, exudates and stellate maculopathy. Hence, post-typhoid immune-mediated retinitis is rare sequelae of typhoid fever which can be treated with good visual outcome using oral steroids.

Highlights

Enteric fever or typhoid is a systemic disease with predominantly enteric manifestations
We present a case of typhoid sequelae as bilateral retinitis with macular star
9 In conjunction with the data that the sensitivity of culture positivity is only 61% (52%-70%, 95% CI) and prior use of antibiotics further reduces the rate of culture-positivity, it can be concluded that typhoid or enteric fever is a common cause of febrile illness in Nepal.[10]

Summary

INTRODUCTION

Enteric fever or typhoid is a systemic disease with predominantly enteric manifestations. CASE REPORT A 20-year-old female, 27 weeks pregnant, attended OPD with 3 week history of painless diminution of vision in both eyes She had typhoid fever 4 weeks prior to presentation and 1 week before the onset of the eye symptoms. BILATERAL POST TYPHOID RETINITIS superficial white fluffy lesions each less than 0.5DD along the superior and inferior temporal vascular arcades with surrounding retinal opacification. Retinal edema had decreased around the vascular arcades and fluffy exudates were more discrete. Post-typhoid sequelae with posterior segment involvement has been stated to be either due to direct invasion by bacteria i.e. panuveitis, endophthalmitis and panophthalmitis or due to immune-mediated phenomena including optic neuritis, vasculitis with branch retinal vein occlusion and subhyaloid hemorrhage at macula.[4]. Post-treatment vision ranged between 6/60 and 6/12 in most cases and fundus lesions resolved leaving retinal pigment epithelial changes and foveal thinning in cases with severe macular involvement.[11]

DISCUSSION

CONCLUSION