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An Endemic Case of West Nile Virus Chorioretinitis in Ohio
Sarah Atta1, Natasha P Kesav, Kevin C Allan
1Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
Purpose:
West Nile virus (WNV) is a mosquito-borne flavivirus known to cause infectious uveitis. This case represents one of the few endemic cases in Ohio without a prior travel history with unique ocular manifestations.
Methods:
Case report.
Results:
A 67-year-old female with past medical history of rheumatoid arthritis and past ocular history of right eye enucleation secondary to childhood penetrating trauma presented with left eye photopsias, floaters, photophobia, and headache. Exam revealed anterior chamber cell, Koeppe nodules, keratic precipitates. Funduscopic exam demonstrated vitreous cell and multifocal chorioretinal lesions. Initial testing was negative, and presumed sympathetic ophthalmia was diagnosed. Treatment with topical and systemic steroids was initiated. Patient recall and exam evolution prompted testing for WNV IgM, which was positive. Systemic and topical corticosteroids were tapered as the patient improved.
Conclusion:
This case highlights the expanding geographic reach of WNV, the potential for infection despite an unremarkable travel or insect bite history, the novel association of WNV with iris nodules and Kyrieleis plaques, and controversial efficacy of systemic corticosteroids in the management of WNV-associated chorioretinitis.
