RESUMEN
PURPOSE: To report a case of bilateral angle-closure associated with systemic hantavirus infection. MATERIALS AND METHODS: A 32-year-old Caucasian man was referred with blurred vision, fever, cough, dyspnea and thrombocytopenia. Ophthalmologic examination revealed myopic shift, elevated intraocular pressure (30 mmHg right eye and 24 mmHg left eye), corneal edema, iridocorneal angle closure and shallow anterior chamber. Ciliochoroidal effusion was detected on anterior segment optical coherence tomography and ultrasound biomicroscopy. Serologic test and polymerase chain reaction confirmed the diagnosis of hantavirus infection and the serotype Puumala. On the sixth day after he started topical anti-glaucoma and cycloplegic medications, the anterior chamber and iridocorneal angles were normalized with disappearance of ciliochoroidal effusion. CONCLUSION: Puumala hantavirus infection is an exceptional cause of acute bilateral angle-closure combined with ciliochoroidal effusion.
Asunto(s)
Efusiones Coroideas/virología , Infecciones Virales del Ojo/virología , Glaucoma de Ángulo Cerrado/virología , Infecciones por Hantavirus/virología , Orthohantavirus/aislamiento & purificación , Enfermedad Aguda , Agonistas de Receptores Adrenérgicos alfa 2/uso terapéutico , Adulto , Anticuerpos Antivirales/sangre , Tartrato de Brimonidina/uso terapéutico , Inhibidores de Anhidrasa Carbónica/uso terapéutico , Efusiones Coroideas/diagnóstico , Efusiones Coroideas/tratamiento farmacológico , Infecciones Virales del Ojo/diagnóstico , Infecciones Virales del Ojo/tratamiento farmacológico , Glaucoma de Ángulo Cerrado/diagnóstico , Glaucoma de Ángulo Cerrado/tratamiento farmacológico , Orthohantavirus/genética , Infecciones por Hantavirus/diagnóstico , Infecciones por Hantavirus/tratamiento farmacológico , Humanos , Presión Intraocular , Masculino , Microscopía Acústica , Miopía/diagnóstico , Miopía/tratamiento farmacológico , Miopía/virología , ARN Viral/sangre , ARN Viral/genética , Reacción en Cadena en Tiempo Real de la Polimerasa , Tomografía de Coherencia Óptica , Tonometría OcularRESUMEN
Acute myopic shift may be the first symptom of a hantavirus infection. In Belgium, lethal infections are rare, but this illness has to be ruled out in the emergency room. The refractive shift has not clearly been explained yet. The ancillary tests to describe this phenomenon are not always performed. This article may help on how to manage and how to explore this disease.
Une myopisation aiguë peut s'avérer être le premier signe d'appel d'une infection par hantavirus. En Belgique, cette virose est rarement létale, mais elle nécessite une prise en charge hospitalière urgente. Le mécanisme exact du trouble visuel reste encore mal expliqué. Les examens complémentaires qui permettraient de décrire le phénomène ne sont pas toujours réalisés. Deux cas nous permettent de faire la lumière sur une meilleure prise en charge et sur les mécanismes à explorer.
Asunto(s)
Infecciones por Hantavirus/complicaciones , Miopía/virología , Enfermedad Aguda , Adulto , Bélgica , Diagnóstico Diferencial , Femenino , Infecciones por Hantavirus/diagnóstico , Humanos , Masculino , Miopía/diagnóstico , Adulto JovenRESUMEN
Puumala virus infection causes epidemic nephropathia (NE), a certain type of haemorrhagic fever with renal syndrome (HFRS). Myopic shift is considered a pathognomonic sign of NE and HFRS but rates of ocular involvement vary. The aim of the study was to evaluate whether clinical and laboratory findings are associated with ophthalmic involvement in NE in Austria. We found that blurred vision and myopic shift are frequent in Puumala virus infections in Austria but are independent of disease severity.