University of Wisconsin–Madison Medical College of Wisconsin

Ocular Findings Aid in Diagnosis of West Nile Virus

Brandon K. Winward, MD; Justin L. Gottlieb, MD; Jonathan S. Chang, MD; E. Luke Bradbury, MD; Nenita Maganti, MD; Chintan Pathak, MD; Benjamin J. Fowler, MD, PhD

WMJ. 2023;122(3):208-212

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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.

Author Affiliations: Maine Medical Center, Portland, Maine (Winward); Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health (UWSMPH), Madison, Wis (Gottlieb, Chang, Maganti, Pathak, Fowler); Department of Neurology, UWSMPH, Madison, Wis (Bradbury).
Corresponding Author: Benjamin J. Fowler, MD, PhD, University of Wisconsin School of Medicine and Public Health, Department of Ophthalmology and Visual Sciences, 2828 Marshal Ct, Suite 200, Madison, WI 52705; phone 608.263.7171; email; ORCID ID 0000-0001-8995-4131
Funding/Support: This work was supported in part by an unrestricted grant from Research to Prevent Blindness, Inc. to the UW-Madison Department of Ophthalmology and Visual Sciences. Dr Fowler received a research fellowship from the Heed Ophthalmic Foundation.
Financial Disclosures: None declared.
Acknowledgments: The authors wish to thank Susan Paskewitz, PhD, from the Department of Entomology, University of Wisconsin-Madison, for her review of the manuscript.
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