GRANULAR HYPERREFLECTIVE SPECKS BY SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY AS SIGNS OF WEST NILE VIRUS INFECTION: THE STARDUST SIGN.

PURPOSE: To report the retinal findings and evolution of a visually symptomatic case of West Nile virus meningoencephalitis.

METHODS

Case report. Main outcome measures include serologic testing for West Nile virus as well as longitudinal funduscopic examination, fluorescein angiography, and spectral domain optical coherence tomography.

RESULTS

A 47-year-old diabetic man was referred for ophthalmic evaluation after hospitalization and treatment for West Nile meningoencephalitis. The patient presented with decreased vision and black spots in the right eye. Baseline visual acuity was 20/100 in the right eye and 20/40 in the left. Funduscopic examination and fluorescein angiography revealed multiple outer-retinal, punctate white spots in the macula and midperiphery of the right eye with no irregularities noted in the left eye. Spectral domain optical coherence tomography revealed granular hyperreflective specks casting variably dense shadows scattered throughout multiple retinal layers, most prominently within the outer and inner nuclear layers of the right eye. The patient was observed over the course of 14 weeks, and final visual acuity was 20/50 in the right eye. Longitudinally, the number of specks progressively decreased.

CONCLUSION

During West Nile virus infection, granular hyperreflective specks located predominantly within the outer and inner nuclear layers were visualized by spectral domain optical coherence tomography and may be a sign of West Nile virus infection.