This 33YO male started to complain of blurred vision 10 days earlier. He was hospitalized two months prior with severe headaches, fever, and chills. Vision was 20/30 OU.
Color imaging shows bilateral Purtscher ‘s-like acute inner macular ischemic whitening with a few retinal hemorrhages. Faint radiating foveal lipid is also present.
OCT scanning shows outer retinal cystic edema and subretinal fluid. Hyperreflective material is adherent to the overlying detached right macula. He was referred for viral bloodwork, but unfortunately was subsequently lost to follow-up.
Learning Points:
Epidemic (post-fever) retinitis was first described by Kawali et al (Ocular Immunology & Inflammation 2019;27:571-577) as an infectious or para-infectious uveitis days to weeks following a febrile illness with Dengue, Rickettsiosis, West Nile, Leptospirosis, Chikungunya, Typhoid, or Ebola. It appears as a usually bilateral Purtscher ’s-like retinitis involving the posterior pole with a favorable response to steroids. It is most common in tropical countries like India.
See Mahendradas et al (Indian J Ophthalmol 2020;68:1775-1786) for an excellent post-fever retinitis review.
