Abstract
BackgroundThis report describes the clinical course of choroidal neovascular membrane (CNV) in West Nile virus-associated chorioretinitis.Case presentationA 28-year-old Italian woman was referred to our institution because of reduced visual acuity in the left eye dating back 4 months. A diagnosis of retinal vasculitis in the right eye and chorioretinitis with CNV in the left eye was made. A complete workup for uveitis revealed positivity only for anti-West Nile virus immunoglobulin M (IgM), while immunoglobulin G (IgG) was negative. Whole-body computed tomography and nuclear magnetic resonance imaging of the brain were also negative. Therefore, the patient was treated with a combination of oral prednisone (starting dose 1 mg/kg per day) and three intravitreal injections of bevacizumab 1.25 mg/0.05 ml, 1 month apart. Fourteen days from starting corticosteroid therapy and after the first intravitreal injection, the patient experienced increased visual acuity to 0.4. Response to therapy was monitored by clinical examination, ocular coherence tomography (OCT), OCT angiography and retinal fluorescein angiography. Three months later, resolution of CNV in the left eye was achieved and no signs of retinal vasculitis were detected in the right eye, while serum IgM for West Nile virus turned negative and IgG positive.ConclusionCNV may be a complication of West Nile virus-associated chorioretinitis, and only subclinical retinal vasculitis may also be found even in non-endemic regions.
Highlights
This report describes the clinical course of choroidal neovascular membrane (CNV) in West Nile virusassociated chorioretinitis.Case presentation: A 28-year-old Italian woman was referred to our institution because of reduced visual acuity in the left eye dating back 4 months
West Nile virus (WNV) is a single-stranded ribonucleic acid (RNA) virus that belongs to the family Flaviviridae
Excluding the most severe cases, for which hospitalization is needed, West Nile chorioretinitis is considered to be a self-limiting pathology with a partial recovery of visual function if secondary inflammatory choroidal neovascularization (CNV) does not occur [5]. The aim of this case report is to describe, in the first case of WNV-associated chorioretinitis diagnosed in Italy, the clinical course of the disease and its complications
Summary
West Nile virus (WNV) is a single-stranded ribonucleic acid (RNA) virus that belongs to the family Flaviviridae. Excluding the most severe cases, for which hospitalization is needed, West Nile chorioretinitis is considered to be a self-limiting pathology with a partial recovery of visual function if secondary inflammatory choroidal neovascularization (CNV) does not occur [5] The aim of this case report is to describe, in the first case of WNV-associated chorioretinitis diagnosed in Italy, the clinical course of the disease and its complications. Two weeks after the onset of systemic lesions, she developed a sudden drop in visual acuity in her left eye She was diagnosed elsewhere with myopiarelated CNV and was treated with two intravitreal injections of ranibizumab 0.5 mg, 1 month apart, without any improvement. Clinical findings During our first examination, she presented with mild myopia (−1.5 diopters) and best-corrected visual acuity (BCVA) of 0.2 in the left eye, normal anterior segment, no cataract, and a partially pigmented yellowish ameboid lesion in the macular region. Final BCVA was 0.5 in the left eye and 1 in the right eye
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