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Make your diagnosis in the comments, and look for the answer in next month’s Blink.

Last Month’s Blink

West Nile Virus Retinopathy

Written by Hongan Chen, MD, Stephanie Wangyu, MD, and Amit Reddy, MD. Photos by Heather Olson. All are at Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora.

A 76-year-old woman with a medical history significant for hypothyroidism, hy­perlipidemia, and a remote branch retinal vein occlusion of the left eye presented to the emergency depart­ment for acute onset of bilateral floaters. The patient had recently been hospitalized for West Nile virus (WNV) meningitis, for which she was treated with intravenous methylprednisolone.

On evaluation, the patient was afebrile with normal mentation. Ocular examination revealed 3+ anterior chamber and vitreous cells in the right eye and trace cells and flare in the left eye. Fundus examination showed bilateral chorioretinal lesions in a linear pattern radiating away from the optic disc (Fig. 1). On fluorescein angiography, the corresponding lesions appeared targetoid with hypofluorescent centers surrounded by hyperfluo­rescent rims (Fig. 2).

WNV neuroinvasive disease develops in ap­proximately 1% of individuals infected with WNV and carries a mortality rate of approximately 10%.¹ Risk factors for developing neuroinvasive disease include advanced age, malignancy, and a history of organ transplantation. Other studies have also suggested male gender and chronic conditions such as cardiovascular disease, diabetes, hyper­tension, renal disease, and alcohol use disorder as additional risk factors.²

WNV retinopathy has been associated with higher rates of diabetes and a history of WNV encephalitis.³

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1 Khairallah M et al. Ophthalmology. 2004;111(11):2065-2070.

2 Murray K et al. Epidemiol Infect. 2006;134(6):1325-1332.

3 Hasbun R et al. PLoS One. 2016;11(3):e0148898.

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