PARACENTRAL ACUTE MIDDLE MACULOPATHY AND HENLE FIBER LAYER HEMORRHAGE IN DENGUE FEVER: MULTIMODAL IMAGING AND REVIEW OF THE LITERATURE.

PURPOSE: To use multimodal imaging to report a case of dengue fever presenting with Henle fiber layer hemorrhage and acute paracentral acute middle maculopathy.

METHODS

Fundus photography and autofluorescence, fluorescein angiography, and optical coherence tomography were acquired over a month, and a literature review of dengue fever-associated maculopathy was performed.

RESULTS

A 19-year-old man presented with a sudden loss of vision in both eyes 12 days after experiencing initial systemic symptoms suggestive of dengue fever. His best-corrected visual acuity was counting fingers in the right eye and 20/200 in the left eye. Pupillary light reflex was reduced in both eyes. Dilated fundoscopic examination revealed optic disk swelling and a small deep Henle fiber layer hemorrhage near the fovea in both eyes. Optical coherence tomography revealed a petaloid shape hyperreflectivity involving both outer nuclear and plexiform layers in both eyes and a subtle hyperreflectivity thinning the inner nuclear layer in the left eye, findings compatible with Henle fiber layer hemorrhage and paracentral acute middle maculopathy, respectively. Immunoglobin M was positive for dengue fever. Thus, a diagnosis of dengue fever-associated maculopathy was made and oral steroids were started. After a month, the final best-corrected visual acuity reached 20/25 (right eye) and 20/20 (left eye), the Henle fiber layer hemorrhage reabsorbed utterly, and an inner nuclear layer thinning in the area of the PAMM was observed.

CONCLUSION

Dengue fever-associated maculopathy can present with PAMM and Henle fiber layer hemorrhage. Multimodal imaging is helpful to characterize the extension of the changes in the retina and to monitor its recovery. In such cases, structural and functional damage may occur despite treatment with oral steroids.