Ocular Findings Aid in Diagnosis of West Nile Virus

Authors

Brandon K. Winward, Maine Medical Center, Portland, Maine.
Justin L. Gottlieb, Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Jonathan S. Chang, Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Luke Bradbury, Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Nenita Maganti, Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Chintan Pathak, Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Benjamin J. Fowler, Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.

Document Type

Article

Publication Date

7-1-2023

Journal Title

WMJ : official publication of the State Medical Society of Wisconsin

MeSH Headings

Male; Humans; Aged; West Nile virus; West Nile Fever (diagnosis); Chorioretinitis (diagnosis); Fluorescein Angiography

Abstract

INTRODUCTION: West Nile virus disease, which is endemic to the United States, is a rarely reported systemic infection that can be difficult to diagnose. Chorioretinitis is an uncommon manifestation of West Nile virus but has pathognomonic ocular findings that can aid in diagnosis. CASE PRESENTATION: A 66-year-old man presented with acute onset fever, chills, and dyspnea. He underwent an extensive but nondiagnostic workup during hospitalization. New visual complaints prompted ophthalmology consultation. Funduscopic examination showed macular hemorrhages and midperipheral chorioretinal lesions. Fluorescein angiography revealed target-like lesions in a radial distribution, which is pathognomonic for West Nile virus chorioretinitis. Serology confirmed the diagnosis of West Nile virus disease. Systemic and ocular symptoms improved with supportive care. DISCUSSION: West Nile virus disease has many nonspecific manifestations. History of recent mosquito exposure is not always readily elicited. In patients with visual symptoms, eye examination can help in its diagnosis. CONCLUSIONS: West Nile virus should be considered in patients with acute febrile or neurological illness during mosquito season.

Comments

Brandon Winward- Resident

First Page

208

Last Page

212

Recommended Citation

Winward BK, Gottlieb JL, Chang JS, et al. Ocular Findings Aid in Diagnosis of West Nile Virus. WMJ. 2023;122(3):208-212.