This 20YO female presented with sudden vision loss in her left eye that followed a 1-week febrile illness. Vision was 20/20 in her normal right eye and 20/30 in her left eye.
Multicolor imaging shows marked disc edema with surrounding retinitis, frosted branch vasculitis, and a nasal macular star. OCT shows marked nasal macular retinal thickening and foveal subretinal fluid. Vitritis was noted clinically, and vitreous cells were also noted on the OCT. Fluorescein angiography shows marked optic nerve leakage and vascular staining.
Oral steroids and doxycycline were recommended, along with Weill-Felix testing to rule out typhoid fever, but unfortunately, she was immediately lost to follow-up.
Learning Points:
Epidemic (post-fever) retinitis is an infectious or para-infectious entity that develops in immunocompetent individuals several weeks following a bacterial, viral, or protozoal infection. Causes include Dengue, Rickettsiosis, West Nile, Leptospirosis, Chikungunya, Typhoid, and Ebola. Patients present with sudden, painless vision loss.
Fundus findings include unilateral or bilateral unifocal or multifocal patches of retinitis with possible nerve involvement, serous macular detachment, and vasculitis or frosted branch angiitis. There is usually a favorable response to steroids and treating the underlying infectious cause with appropriate systemic therapy.
See Mahendradas et al (Indian J Ophthalmol 2020;68:1775-1786) for an excellent post-fever retinitis review.
