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Chikungunya virus iridocyclitis in Fuchs' heterochromic iridocyclitis.

Mahendradas P, Shetty R, Malathi J, Madhavan HN - Indian J Ophthalmol (2010 Nov-Dec)

Bottom Line: She had a tripod dendritic pattern of keratic precipitates by confocal microscopy in the left eye with a stippled pattern of keratic precipitates in both eyes.The real-time polymerase chain reaction (RT-PCR) assay in the aqueous humor detected 98 copies/ml of chikungunya virus RNA.This is the first report where the presence of chikungunya virus RNA has been associated with a case of bilateral Fuchs' heterochromic iridocyclitis.

View Article: PubMed Central - PubMed

Affiliation: Uveitis and Ocular Immunology Services, Narayana Nethralaya, Superspeciality Eye Hospital and Post Graduate Institute of Ophthalmology, 121/C, Chord Road, Rajajinagar, 1st R Block, Bangalore - 560 010, Karnataka, India. m.padmamalini@gmail.com

ABSTRACT
We are reporting a case of bilateral Fuchs' heterochromic iridocyclitis with chikungunya virus infection in the left eye. A 20-year-old female was presented with a past history of fever suggestive of chikungunya with bilateral Fuchs' heterochromic iridocyclitis and complicated cataract. She had a tripod dendritic pattern of keratic precipitates by confocal microscopy in the left eye with a stippled pattern of keratic precipitates in both eyes. The real-time polymerase chain reaction (RT-PCR) assay in the aqueous humor detected 98 copies/ml of chikungunya virus RNA. The patient underwent clear corneal phacoemulsification with in-the-bag intraocular lens implantation in the left eye with a good visual outcome. This is the first report where the presence of chikungunya virus RNA has been associated with a case of bilateral Fuchs' heterochromic iridocyclitis.

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Slit-lamp biomicroscopic photograph of the right eye revealed fine-to-medium-sized keratic precipitates with heterochromia of the iris
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Figure 0001: Slit-lamp biomicroscopic photograph of the right eye revealed fine-to-medium-sized keratic precipitates with heterochromia of the iris

Mentions: A 20-year-old female of Indian origin presented with the complaint of decreased vision in the left eye since 2 weeks. One week prior to the onset of ocular symptoms, the patient had fever lasting for 3 days suggestive of chikungunya fever. Her ocular history was negative for trauma and previous inflammation. Her old investigational reports ordered by the physician revealed positive serum anti-rubella virus IgG (153 IU/ml), and serum toxoplasma, cytomegalovirus, and herpes simplex virus antibodies were negative. Her best corrected visual acuity was 20/30 in the right eye and counting finger close to face in the left eye. Intraocular pressure was normal in both the eyes. Slit-lamp biomicroscopy in the right eye demonstrated fine-to-medium-sized keratic precipitates, flare+, cells+, stromal atrophy of the iris [Fig. 1], nodules on the pupillary margin, and grade I posterior subcapsular opacity. The left eye revealed fine pigments on the corneal endothelium, flare+, cells+, small nodules on the iris [Fig. 2A], and shallow anterior chamber with a mature cataract in the left eye [Fig. 2B]. Gonioscopy revealed open angles in both eyes. Fundus examination of the right eye revealed vitritis+, vitreous haze+ with normal posterior segment; B-scan ultrasonography revealed few vitreous opacities with attached retina in the left eye. Confocal microscopy revealed a new tripod dendritic pattern with stippled keratic precipitates [Fig. 3] in the left eye with a stippled pattern of keratic precipitates in the right eye.


Chikungunya virus iridocyclitis in Fuchs' heterochromic iridocyclitis.

Mahendradas P, Shetty R, Malathi J, Madhavan HN - Indian J Ophthalmol (2010 Nov-Dec)

Slit-lamp biomicroscopic photograph of the right eye revealed fine-to-medium-sized keratic precipitates with heterochromia of the iris
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2993993&req=5

Figure 0001: Slit-lamp biomicroscopic photograph of the right eye revealed fine-to-medium-sized keratic precipitates with heterochromia of the iris
Mentions: A 20-year-old female of Indian origin presented with the complaint of decreased vision in the left eye since 2 weeks. One week prior to the onset of ocular symptoms, the patient had fever lasting for 3 days suggestive of chikungunya fever. Her ocular history was negative for trauma and previous inflammation. Her old investigational reports ordered by the physician revealed positive serum anti-rubella virus IgG (153 IU/ml), and serum toxoplasma, cytomegalovirus, and herpes simplex virus antibodies were negative. Her best corrected visual acuity was 20/30 in the right eye and counting finger close to face in the left eye. Intraocular pressure was normal in both the eyes. Slit-lamp biomicroscopy in the right eye demonstrated fine-to-medium-sized keratic precipitates, flare+, cells+, stromal atrophy of the iris [Fig. 1], nodules on the pupillary margin, and grade I posterior subcapsular opacity. The left eye revealed fine pigments on the corneal endothelium, flare+, cells+, small nodules on the iris [Fig. 2A], and shallow anterior chamber with a mature cataract in the left eye [Fig. 2B]. Gonioscopy revealed open angles in both eyes. Fundus examination of the right eye revealed vitritis+, vitreous haze+ with normal posterior segment; B-scan ultrasonography revealed few vitreous opacities with attached retina in the left eye. Confocal microscopy revealed a new tripod dendritic pattern with stippled keratic precipitates [Fig. 3] in the left eye with a stippled pattern of keratic precipitates in the right eye.

Bottom Line: She had a tripod dendritic pattern of keratic precipitates by confocal microscopy in the left eye with a stippled pattern of keratic precipitates in both eyes.The real-time polymerase chain reaction (RT-PCR) assay in the aqueous humor detected 98 copies/ml of chikungunya virus RNA.This is the first report where the presence of chikungunya virus RNA has been associated with a case of bilateral Fuchs' heterochromic iridocyclitis.

View Article: PubMed Central - PubMed

Affiliation: Uveitis and Ocular Immunology Services, Narayana Nethralaya, Superspeciality Eye Hospital and Post Graduate Institute of Ophthalmology, 121/C, Chord Road, Rajajinagar, 1st R Block, Bangalore - 560 010, Karnataka, India. m.padmamalini@gmail.com

ABSTRACT
We are reporting a case of bilateral Fuchs' heterochromic iridocyclitis with chikungunya virus infection in the left eye. A 20-year-old female was presented with a past history of fever suggestive of chikungunya with bilateral Fuchs' heterochromic iridocyclitis and complicated cataract. She had a tripod dendritic pattern of keratic precipitates by confocal microscopy in the left eye with a stippled pattern of keratic precipitates in both eyes. The real-time polymerase chain reaction (RT-PCR) assay in the aqueous humor detected 98 copies/ml of chikungunya virus RNA. The patient underwent clear corneal phacoemulsification with in-the-bag intraocular lens implantation in the left eye with a good visual outcome. This is the first report where the presence of chikungunya virus RNA has been associated with a case of bilateral Fuchs' heterochromic iridocyclitis.

Show MeSH
Related in: MedlinePlus