Unilateral foveolitis, hyperhomocysteinemia, and dengue fever

Abstract

We describe a unique case of post-dengue fever (DF) central retinal vein occlusion (CRVO) with foveolitis and concomitant hyperhomocystinemia. A 21-year-old Asian Indian woman presented with a sudden decrease in vision in left eye (OS) 3 days after fever. Clinically she had impending CRVO with foveolitis in OS. Serology for dengue immunoglobulin G was positive (65.74) and serum homocysteine level was elevated (>50). Spectral-domain optical coherence tomography revealed posterior vitreous cells, altered foveal contour, a well-defined area of hyperreflectivity in the subfoveal region with disruption of outer nuclear layer, and external limiting membrane with subretinal fluid with intact retinal pigment epithelium suggestive of the foveolitis, most commonly described in DF. She was treated with systemic steroids and folic acid, with complete resolution of her clinical signs after 6 weeks. In addition to the hematological workup, history of fever DF should be considered as a possible etiology in a case of vein occlusion