Abstract
BackgroundDengue fever is a mosquito-borne illness prevalent mainly in the tropics. It is feared for causing the dengue hemorrhagic spectrum of the disease leading to significant morbidity and mortality. Its rarer manifestations are categorized as the expanded dengue syndrome, and though being recognized, they are not fully appreciated and understood. The involvement of the eye in dengue fever is one such phenomenon.Case presentationA 27-year-old South-Asian woman presented on day 2 of dengue fever, without capillary leakage, for further management. Despite developing hepatitis, she had an otherwise uncomplicated progression of the illness because she did not develop capillary leakage. On day 8 of the illness, she had the lowest platelet count and developed bilateral blurred vision. Examination revealed that only gross movements were detected in the left eye, and the right eye had a visual acuity of 6/9. She was diagnosed with foveolitis in the right eye and central serous chorioretinopathy in the left eye, along with hemorrhages in both eyes. These were confirmed by funduscopy, fluorescein angiography, optical coherence tomography, and macular scans. She received systemic and intravitreal steroids and was assessed regularly. After 6 months of observation, her visual acuity was 6/6 in the right eye and 6/9 in the left eye, which remained the same thereafter.DiscussionThe exact mechanism of eye involvement in dengue viral infection is poorly understood. Multiple causes have been suspected and include viral factors, immune mediation, capillary leakage, stress, and hemorrhage. Eye involvement is classically seen at the lowest platelet count and when the count begins to rise. Though symptoms are nonpathognomonic, blurring of vision is the commonest complaint, but the range of presentation is extensive and variable. Ophthalmological assessment and funduscopy are very useful in addition to advanced assessments. There is no clear consensus on management; suggestions range from conservative care to aggressive steroid therapy with immune modulation and even ophthalmological intervention. Recovery can be full or partial with a variable time scale.ConclusionThe extensive spectrum of possible visual symptoms should prompt the clinician to suspect any visual complaint as potential dengue eye involvement. Guided studies and screening are needed to better understand the true incidence of eye involvement in dengue fever.
Highlights
Dengue fever is a mosquito-borne illness prevalent mainly in the tropics
The extensive spectrum of possible visual symptoms should prompt the clinician to suspect any visual complaint as potential dengue eye involvement
We describe a patient with dengue viral infection who developed ocular complications with residual deficit attributable to the disease, and we stress the importance of appreciating the potential rarer and less recognized complications that can occur due to dengue viral infection which can have a permanent impact
Summary
This case report highlights the less frequently seen but important complications that can occur with dengue viral infection. With profound visual impact, the role of active treatment vs passive approach becomes questionable, especially when strict guidance is unavailable In this case report, we attempt to give some insight into the etiopathogenesis, clinical picture, progression, investigations, and treatment options available following ocular involvement in dengue viral fever, and we describe the decisions we made for the ocular complications we encountered based on available evidence, in addition to the patient’s outcome. Uncommon occurrences include CSCR, which has been observed in dengue [15] These manifestations can at times occur for the first time, months after the recovery of an otherwise uncomplicated dengue viral infection, as noted by Gupta et al in their case series in which uveitis was seen as a delayed phenomenon, stressing the need for vigilance [6]. With lack of clearly defined guidelines, the decision should be at the discretion of the clinical team and the patient
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