Department of Ophthalmology, Hospital "F. Miulli", Acquaviva delle Fonti, 70124, Bari, Italy.
Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari "Aldo Moro", 70124, Bari, Italy.
J Med Case Rep. 2021 Apr 19;15(1):206. doi: 10.1186/s13256-021-02700-0.
This report describes the clinical course of choroidal neovascular membrane (CNV) in West Nile virus-associated chorioretinitis.
A 28-year-old Italian woman was referred to our institution because of reduced visual acuity in the left eye dating back 4 months. A diagnosis of retinal vasculitis in the right eye and chorioretinitis with CNV in the left eye was made. A complete workup for uveitis revealed positivity only for anti-West Nile virus immunoglobulin M (IgM), while immunoglobulin G (IgG) was negative. Whole-body computed tomography and nuclear magnetic resonance imaging of the brain were also negative. Therefore, the patient was treated with a combination of oral prednisone (starting dose 1 mg/kg per day) and three intravitreal injections of bevacizumab 1.25 mg/0.05 ml, 1 month apart. Fourteen days from starting corticosteroid therapy and after the first intravitreal injection, the patient experienced increased visual acuity to 0.4. Response to therapy was monitored by clinical examination, ocular coherence tomography (OCT), OCT angiography and retinal fluorescein angiography. Three months later, resolution of CNV in the left eye was achieved and no signs of retinal vasculitis were detected in the right eye, while serum IgM for West Nile virus turned negative and IgG positive.
CNV may be a complication of West Nile virus-associated chorioretinitis, and only subclinical retinal vasculitis may also be found even in non-endemic regions.
本报告描述了西尼罗河病毒相关性视网膜炎脉络膜新生血管（CNV）的临床病程。
一名 28 岁的意大利女性因左眼视力下降 4 个月而被转诊至我院。右眼视网膜血管炎和左眼脉络膜视网膜炎合并 CNV 的诊断成立。全面检查发现仅抗西尼罗河病毒免疫球蛋白 M（IgM）阳性，而 IgG 阴性。全身计算机断层扫描和脑磁共振成像也为阴性。因此，患者接受了口服泼尼松（起始剂量 1 mg/kg/天）联合贝伐单抗（1.25 mg/0.05 ml）3 次玻璃体内注射治疗，间隔 1 个月。开始皮质类固醇治疗后 14 天，以及第一次玻璃体内注射后，患者的视力提高到 0.4。通过临床检查、眼部相干断层扫描（OCT）、OCT 血管造影和视网膜荧光血管造影监测治疗反应。3 个月后，左眼 CNV 得到缓解，右眼未发现视网膜血管炎迹象，而西尼罗河病毒血清 IgM 转为阴性，IgG 阳性。
CNV 可能是西尼罗河病毒相关性视网膜炎的并发症，即使在非流行地区，也可能仅发现亚临床视网膜血管炎。
