West nile virus occlusive retinal vasculitis.

OBJECTIVE

To report a case of West Nile virus meningoencephalitis presenting with simultaneous chorioretinitis in the right eye and occlusive retinal vasculitis in the left eye.

METHODS

Case report. Main outcome measures included ocular examination, intravenous fluorescence angiography, indocyanine green, color fundus photography, and serologic testing for West Nile virus.

RESULTS

A 45-year-old white woman presented with severe loss of vision in the left eye (count fingers at 3 feet) 2 weeks after an episode of hospitalization for fever of unknown origin. Examination showed extensive retinal opacification and edema in the left eye with arteriolar narrowing. Intravenous fluorescence angiography confirmed delayed venous return superiorly, multiple arteriolar occlusions, large area of nonperfusion, and vascular staining and leakage. Indocyanine green highlighted bilateral well-deliniated hypocyanescent choroidal lesions corresponding to the subretinal lesions seen by ophthalmoscopy. Indocyanine green allowed identification of additional lesions that were not initially detected on intravenous fluorescence angiography and ophthalmoscopy.

CONCLUSIONS

Occlusive retinal vasculitis is a rare yet important ocular manifestation of West Nile virus infection. It may occur in young patients without diabetes, and unlike West Nile virus chorioretinitis, it is often associated with poor visual outcome.