Sir,

We herein report a young girl developing bilateral vitreous haemorrhage as an ocular manifestation of dengue haemorrhagic fever (DHF).

Case report

A 14-year-old girl presented with diminution of vision in right eye since 4 months. She had high-grade fever with chills, muscle pain, headache, and episodes of bleeding through mouth and during defaecation 2 days before developing eye problems. DHF was confirmed by detection of rise in IgG dengue fever antibody titre and markedly decreased platelet counts. Examination revealed bilateral vitreous haemorrhage. She was referred to us after her general condition improved.

At presentation, she had light perception OD and 6/18 OS. Anterior segment examination was unremarkable in both eyes. Fundus examination revealed organized vitreous haemorrhage OD and resolving vitreous haemorrhage OS. Right eye pars plana vitrectomy was performed. No surgery was planned in left eye. At 12 weeks postoperatively (Figure 1), her visual acuity was 6/12 in both eyes.

Figure 1
figure 1

Fundus photograph of the right eye 8 weeks postoperative showing wrinkling of internal limiting membrane at the posterior pole and fibrous tissue laden with degenerated blood along inferotemporal arcade and disc.

Full size image

Discussion

DHF is a mosquito-transmitted viral disease1 that is endemic in tropical countries. Patient typically develops sudden onset of fever with severe headache, retrobulbar pain, backache, chills, gastrointestinal disturbances, and generalized myalgias and arthralgias. A maculopapular rash usually appears on trunk spreading to face and extremities. Fever is accompanied by leucopenia and thrombocytopenia. The diagnosis can be made by detecting IgM antibodies or a rise in IgG titres during the convalescent phase or by isolation of virus or polymerase chain reaction dengue viral genome.2, 3

Such presentation of bilateral intraocular haemorrhage may be seen in Rift Valley fever (RVF) virus infection. However, RVF is predominantly associated with exudate-like retinal lesions.4 Similarly, if patient presents with bilateral vitreous haemorrhage, severe headache and myalgias after initial fever and rashes of DHF have subsided, he may be misdiagnosed as a case of Terson syndrome.

Ocular manifestations2, 5 reported in DHF are intraretinal haemorrhage, macular haemorrhage, Roth spots, cotton wool spots, retinal oedema, disc oedema, or choroidal effusion. Our patient developed bilateral vitreous haemorrhage, significant enough in right eye that required vitrectomy. She had marked thrombocytopenia and detection of rise in the IgG dengue fever antibody titre confirmed DHF. To the best of our knowledge, till date, vitreous haemorrhage as a part of ocular manifestation of DHF have not been reported earlier.