A 35-year-old woman came to our hospital on November 22, 2010, after the onset of unilateral blurred vision and scotomata, purpuric rash over bilateral lower limbs, and metrorrhagia for four days. She had visited Vietnam for 11 days and fever, chills, and headache subsequently developed one day after returning to Japan. Fever and headache subsided six days after onset of disease.
Laboratory data showed a platelet count of 109,000 cells/μL, dengue virus nonstructural protein 1, and IgM against dengue virus 10 days after onset of disease. Visual acuity was reduced to 20/25 in the left eye. Humphrey visual field testing showed nonspecific visual field defects. Funduscopic examination showed retinal hemorrhages and white spots (Figure 1). She was observed without treatment.
Blurring of vision and scotomata typically coincides with thrombocytopenia and clinical features include blot hemorrhages.1,2 Visual recovery usually corresponds with improving platelets levels, however, scotomata may persist for several weeks in some cases despite the resolution of ocular signs.1 The patient described small scotomata 19 days after onset of disease despite the resolution of thrombocytopenia and hemorrhagic spots (Figure 2). Her visual symptoms improved and visual acuity improved to 20/17 at 84 days after onset of disease.
Chan DP, Teoh SC, Tan CS, Nah GK, Rajagopalan R, Prabhakaragupta MK, Chee CK, Lim TH, Goh KY, Eye Institute Dengue-Related Ophthalmic Complications Workgroup, Dengue Maculopathy Study Group, 2006. Ophthalmic complications of dengue. Emerg Infect Dis 12: 285–289.