Título

Ocular manifestations of vertical transmission of dengue

Objetivo

To report here a 6-week old baby with retinal findings similar to dengue retinopathy and, what we to the best of our knowledge believe to be the first case of ocular manifestation consequent to vertical transmission from mother to child.

Relato do Caso

A healthy woman in her 38th week of pregnancy exhibited signs and symptoms of dengue with fever, arthralgia and myalgia. The clinical diagnosis of dengue was confirmed by serology. On the day of diagnosis she had a platelet count of 180,000 cells/mm³. With clinical and hematological worsening, there was a significant and abrupt reduction of the platelet count to 3000 cells/mm³. With progression to severe dengue, it was necessary to hospitalize the patient. At 38 weeks and 6 days of pregnancy she had premature rupture of membranes with consequent fetal distress, requiring an emergency cesarean delivery.
The baby boy suffered two episodes of cardiorespiratory arrest and remained in the ICU for 29 days with a diagnosis of fetal anoxia. At 7 weeks of age, with a positive serology for dengue, he was referred to the retina and vitreous service of the Faculty of Medicine of Ribeirão Preto University Hospital, for further investigation.On admission, fundus examination of the right eye(OD) revealed gray vitreous hemorrhage, and preretinal and retinal hemorrhages in all four quadrants. Examination of the left eye(OS) showed similar findings, with preretinal and retinal hemorrhages only in the superior equatorial retina. Ocular ultrasound revealed punctiform vitreous echoes of low echogenicity suggestive of an inflammatory/hemorrhagic process in both eyes (FIG 01 A-D).Six weeks after presentation, there was a decrease of vitreous opacities and preretinal and retinal hemorrhages in both eyes. There was also one cotton wool spot in the superior nasal retinal of OD and one in the temporal equatorial retina of OS. The ultrasound confirmed reduction of vitreous opacities(FIG 02 A-F).

Conclusão

Retinal and vitreous hemorrhages as well as small vessel occlusions may be the presenting signs of vertical transmission of dengue.