Author: Sweety Pohane (India)
Co-authors: Abhishek Desai, Rushikesh Naigaonkar, Mihir Trivedi
Post fever retinitis is retinal manifestations seen after a systemic febrile illness caused by either bacteria, viruses, or protozoa. These manifestations may be the result of a direct invasion by the pathogen or by indirect invasion mediated through immune-modulated mechanisms. Retinitis and vasculitis manifested between 2 - 4 weeks after the fever irrespective of etiology. A case of post fever retinitis in a 23 year pregnant female managed successfully.
A 23 yr old female presented with sudden diminution of vision in left eye since 4 days while 28 weeks pregnant, in Vitreo- Retina department of SHRI GANAPATI NETRALAYA , JALNA , MAHARASHTRA (INDIA).
A 23 yr old female presented with sudden diminution of vision in left eye since 4 days while 28 weeks pregnant. She had a fever with chills a month ago (treated adequately). The Patient was investigated extensively to rule out any infectious etiology but none found( viz enteric fever, HIV, Dengue ,Cat-scratch disease, Chikanguniya, malaria, Syphilis, Lyme disease and Covid-19). At presentation, her BCVA in right eye was, 20/20 ,N6 & left eye 1/20, N36. Left eye fundus showed mild vitritis, a patch of vasculitis and retinitis along superior and inferotemporal arcade with gross macular edema, hard exudates on macula & hyperaemic disc.Her right eye was within normal limit.FFA deferred in view of pregnancy. Left eye OCT at presentation revealed increased hyperreflectivity with thickening of inner retinal layers, hyperreflective dots intraretinally with subretinal fluid in perifoveal area.Her right eye OCT was unremarkable. Systemic steroids are the mainstay of treatment in this condition. However, Patient and her treating Obstetrician denied for any systemic medication hence after obtaining informed consent from patient , she was treated with intravitreal dexamethasone implant (OZURDEX®).
She did well post procedure- Inflammation resolved with anatomical and functional success with left eye visual acuity improved to20/20 ,N6 at 6 weeks and maintained same throughout her visits (last follow up 3 months post delivery ). No other adverse events occured for the mother or baby neither during pregnancy nor after delivery.
This was a very challenging scenario and to the best of our knowledge, this is the first report of post fever retinitis treated with intravitreal dexamethasone implant in pregnancy. Many cases of post fever retinitis do not have etiological diagnosis & good response to steroids suggestive of possible immunological etiology. This may represent a suitable therapeutic option when other approaches are contraindicated.
NO FINANCIAL DISCLOSURES