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Physical exam: Unremarkable Slit lamp exam:

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Physical exam: Unremarkable Slit lamp exam:

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  1. Dengue fever, caused by a virus of the flaviviridae family, is a common ailment to the Puerto Rican population. It has received even more attention with its increasing incidence in tourists traveling through these and other endemic areas (Americas: Dominican Republic, Cuba, Brazil, Mexico, and Asia Pacific). In addition to the more documented, thrombocytopenic- hemorrhagic phenomena, dengue fever has documented ocular pathology ranging from optic neuropathy (1) to macular disease, which usually occurs at the nadir of the thrombocytopenia. The maculopathy has been reported to occur with a prevalence of as high as 10 percent of seropositive dengue fever cases in a recent study (2). The etiology of dengue maculopathy has been proposed to be associated with an immunological reaction to the virus by various authors. The permanence of vision loss and the role of immunosuppression remain to be established. We present the first case of dengue maculopathy to be reported in the island of Puerto Rico. CC: A 22y/o male inmate was referred to our clinics with a chief complaint of painless, bilateral loss of vision since the previous day. HPI: Patient refers associated photopsias and floaters. Refers he had been sick since 10 days before with general malaise, dizziness, fever, diaphoresis and arlthralgias. Denies headaches, seizures, sinusitis, cough, nausea, vomits, chest or abdominal pain, dysuria or paresthesias. Last refraction 1 year before with referred good visual acuity. PMHX: Patient refers history of fatigue as a child and no history of systemic illnesses or sexually transmitted diseases. No known drug allergies. No use of medications. No prior surgeries. No toxic habits ( denies illicit drug use, tobacco or alcohol). Labs: (One month after onset of viral illness) Introduction • After diagnostic tests were studied our patient was maintained under observation. Two months after our initial evaluation, patient presented with visual acuity of CF 2 ft OD and 20/400 PH 20/70 OS and applanationtonometry of 15 and 16 respectively. Slit lamp examination was unremarkable. • Fundus: Right Left • OCT: • Dengue fever maculopathy may present with retinal edema, intraretinal hemorrhages, vasculitis, and cotton wool spots. Spontaneous resolution of macular edema, and retinal findings, with partial improvement in visual acuity were observed, but whether full recovery to pre-maculopathy baseline visual function is achieved remains to be investigated. As is the role of immunosuppresion therapy and the prevalence of dengue maculopathy in the Dengue fever affected population. • Sanjay S, Wagle AM, Au Eong KG. Opticneuropathyassociatedwith dengue fever. Eye. 2008 Mar 14 • Su DH, Bacsal K, Chee SP, Flores JV, Lim WK, Cheng BC, Jap AH; Dengue Maculopathy Study Group. Prevalence of dengue maculopathy in patientshospitalizedfor dengue fever. Ophthalmology. 2007 Sep;114(9):1743-7. • Bacsal KE, Chee SP, Cheng CL, Flores JV.Dengue-associatedmaculopathy. Arch Ophthalmol. 2007 Apr;125(4):501-10 • Siqueira RC, Vitral NP, Campos WR, Oréfice F, de Moraes Figueiredo LT. Ocular manifestations in Dengue fever. Ocul Immunol Inflamm. 2004 Dec;12(4):323-7 • Chan DP, Teoh SC, Tan CS, Nah GK, Rajagopalan R, Prabhakaragupta MK, Chee CK, Lim TH, Goh KY; The Eye Institute Dengue-Related Ophthalmic Complications Workgroup. Ophthalmiccomplications of dengue. Emerg Infect Dis.2006 Feb;12(2):285-9 Physical exam: Unremarkable Slit lamp exam: Revealed visual acuity of hand motion of both eyes. Applanationtonometry revealed 17 OD and 18 OS. Lids revealed no pathology. Neither did sclera or conjunctiva examination. Anterior segment examination revealed intact cornea. Anterior chamber was deep and quiet in both eyes. Pupils were round, reactive to light with no RAPD. Lenses were essentially clear in both eyes. Fundus: Right Left Fluorescein Angiography: OCT: .Clinical Case Report: Dengue Retinopathy.Stella Casillas MD , Horacio M. Tous MD , Juan Santiago MD, and Vanessa Cruz MD From the Department of Ophthalmology, University of Puerto Rico, Medical Science Campus Case Report Conclusion References

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