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Bilateral retinitis following typhoid fever

View Article: PubMed Central - PubMed

ABSTRACT

Background: Post typhoid fever immune related reactions affecting the eye is a rare finding which can have various presentations in which typhoid retinopathy is not a well recognized sequelae.

Case presentation: Here we present a case of 59 year old male who presented with right eye sudden painless loss of vision 4 weeks after typhoid fever which was diagnosed and treated successfully. His BCVA was 2/60 in right eye and 6/6 in left eye. Fundus examination showed retinitis along with macular serous detachment in right eye and retinitis in left eye. Significant improvement in BCVA in right eye was observed after treatment with oral steroid with resolving retinitis lesions. Diagnosis of post typhoid immune mediated retinitis was made with good resolution following treatment.

Conclusions: Immune mediated retinitis is a rare sequelae to typhoid infection which can be successfully treated with systemic steroids with good resolution of the lesions.

No MeSH data available.


Related in: MedlinePlus

a Post treatment fundus photo of right eye showing resolved retinitis lesions with few dispersed hard exudates. b Post treatment fundus photo of left eye with resolved retinitis lesions
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Fig3: a Post treatment fundus photo of right eye showing resolved retinitis lesions with few dispersed hard exudates. b Post treatment fundus photo of left eye with resolved retinitis lesions

Mentions: A 59 year old male presented to our hospital 1 week after experiencing diminution of vision in the right eye. He gave a history of typhoid fever 4 weeks prior to presentation for which Widal test was performed to confirm diagnosis. The test results showed significant titres for ‘O’ antigen (>1:80) and ‘H’ antigen (>1:160) and negative for ‘AH’ and ‘BH’ antigens. He was subsequently started on oral Ofloxacin 400 mg twice daily for 2 weeks following which fever subsided. There was no known history of diabetes mellitus or hypertension. On ocular examination his best corrected visual acuity was 2/60 in the right eye and 6/6 in left eye. Anterior segment findings were unremarkable with IOP being within normal range for both eyes. Fundus examination of right eye showed white fluffy lesions along the superior and inferior arcades with superficial haemorrhages in around the macula with a macular star suggestive of retinitis (Fig. 1a). Left eye fundus showed few dispersed retinitis lesions with superficial haemorrhage along the superior arcade with intact foveal reflex (Fig. 1b). On optical coherence tomography of right eye underlying macular serous retinal detachment was noted (Fig. 2a). Blood tests were done to rule out VDRL and HIV status. X-cyton analysis of the anterior chamber aspirate was negative for organisms like Mycobacterial Tuberculosis, Toxoplasma Gondii, Hepes Simplex Virus, Cytomegalovirus and Varicella Zoster Virus. After analysis of the reports diagnosis of post typhoid retinitis in both eyes was made. Patient was started on oral prednisolone 1 mg/kg body weight which was tapered over 2 months along with monitoring of systemic and ocular health. Patient came for follow up every 2 weeks for 3 months. Every visit fundus photo was documented. After 2 months of initiating treatment there was an improvement in the BCVA in right eye to 6/6 which was maintained on further visits. Fundus examination revealed resolving lesions in both eyes (Fig. 3a, b) and OCT of the right eye showed resolution of the serous detachment (Fig. 2b).Fig. 1


Bilateral retinitis following typhoid fever
a Post treatment fundus photo of right eye showing resolved retinitis lesions with few dispersed hard exudates. b Post treatment fundus photo of left eye with resolved retinitis lesions
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5385597&req=5

Fig3: a Post treatment fundus photo of right eye showing resolved retinitis lesions with few dispersed hard exudates. b Post treatment fundus photo of left eye with resolved retinitis lesions
Mentions: A 59 year old male presented to our hospital 1 week after experiencing diminution of vision in the right eye. He gave a history of typhoid fever 4 weeks prior to presentation for which Widal test was performed to confirm diagnosis. The test results showed significant titres for ‘O’ antigen (>1:80) and ‘H’ antigen (>1:160) and negative for ‘AH’ and ‘BH’ antigens. He was subsequently started on oral Ofloxacin 400 mg twice daily for 2 weeks following which fever subsided. There was no known history of diabetes mellitus or hypertension. On ocular examination his best corrected visual acuity was 2/60 in the right eye and 6/6 in left eye. Anterior segment findings were unremarkable with IOP being within normal range for both eyes. Fundus examination of right eye showed white fluffy lesions along the superior and inferior arcades with superficial haemorrhages in around the macula with a macular star suggestive of retinitis (Fig. 1a). Left eye fundus showed few dispersed retinitis lesions with superficial haemorrhage along the superior arcade with intact foveal reflex (Fig. 1b). On optical coherence tomography of right eye underlying macular serous retinal detachment was noted (Fig. 2a). Blood tests were done to rule out VDRL and HIV status. X-cyton analysis of the anterior chamber aspirate was negative for organisms like Mycobacterial Tuberculosis, Toxoplasma Gondii, Hepes Simplex Virus, Cytomegalovirus and Varicella Zoster Virus. After analysis of the reports diagnosis of post typhoid retinitis in both eyes was made. Patient was started on oral prednisolone 1 mg/kg body weight which was tapered over 2 months along with monitoring of systemic and ocular health. Patient came for follow up every 2 weeks for 3 months. Every visit fundus photo was documented. After 2 months of initiating treatment there was an improvement in the BCVA in right eye to 6/6 which was maintained on further visits. Fundus examination revealed resolving lesions in both eyes (Fig. 3a, b) and OCT of the right eye showed resolution of the serous detachment (Fig. 2b).Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: Post typhoid fever immune related reactions affecting the eye is a rare finding which can have various presentations in which typhoid retinopathy is not a well recognized sequelae.

Case presentation: Here we present a case of 59 year old male who presented with right eye sudden painless loss of vision 4 weeks after typhoid fever which was diagnosed and treated successfully. His BCVA was 2/60 in right eye and 6/6 in left eye. Fundus examination showed retinitis along with macular serous detachment in right eye and retinitis in left eye. Significant improvement in BCVA in right eye was observed after treatment with oral steroid with resolving retinitis lesions. Diagnosis of post typhoid immune mediated retinitis was made with good resolution following treatment.

Conclusions: Immune mediated retinitis is a rare sequelae to typhoid infection which can be successfully treated with systemic steroids with good resolution of the lesions.

No MeSH data available.


Related in: MedlinePlus