West Nile Virus Choroiditis with Panuveitis

Abstract

Abstract: : Purpose: To investigate the ocular manifestations of severe West Nile virus infection. Methods: A retrospective case series analyzing the ophthalmic manifestations of visually symptomatic patients with history of antecedent West Nile virus infection confirmed by serum or cerebrospinal fluid titers. Five patients were evaluated with ophthalmic examination, fundus photography, and fluorescein angiography. Results: All patients were older than fifty years of age; the same age group in which the incidence of meningoencephalitis is markedly higher. The mean age was 73 years with a median age of 77. All patients had severe West Nile virus infection requiring medical attention, often hospitalization. Patients had subjective visual complaints of blurred vision and floaters that developed during the subacute and convalescent stages of the infection. Visual acuity upon presentation ranged from 20/25 to 20/200. All five patients had bilateral involvement. Patients had evidence of posterior uveitis with multifocal choroidal lesions, which eventually led to hyperplastic retinal pigment epithelial changes. The most prominent lesions were in the macula and nasal aspect of the eye, though all quadrants were involved, and the lesions were best seen on fluorescein angiography. These lesions gradually became more atrophic with resolution of the uveitis and improvement of vision. Conclusions: This series represents the first report of choroiditis and uveitis as a manifestation of West Nile virus. The ocular manifestations appear to be self-limiting with spontaneous improvement in visual function. However, awareness of these ocular manifestations of West Nile virus may assist in the proper diagnosis and management of affected patients as the virus becomes more prominent in the western hemisphere.

Keywords: choroid • inflammation • chorioretinitis