Título

RARE NEURO-OPHTHALMIC FEATURES IN DENGUE FEVER

Objetivo

Describe the immunoregulation and inflammation in DENV and an unusual immune-mediated presentation of optic neuropathy.

Método

Describe the new correlations of dengue fever chain reaction, involving pre-existing DENV heterotypic antibodies and innate immune cells, that causes dysfunction in complement system activity and contributes to the action of autoantibodies, viral amplification and immune-mediated presentation of optic neuropathy.

Resultado

The incidence of optic neuritis ranges from 0–1.5% in clinical studies. Optic neuritis may be bilateral, unilateral, isolated, or associated with dengue maculopathy. Spontaneous visual recovery is possible in dengue fever associated optic neuritis; however, severe permanent visual loss has also been reported. A case report in Malaysia described a patient with bilateral optic neuritis also associated with dengue maculopathy. Anterior ischaemic optic neuropathy is another reported rare neuro-ophthalmic manifestation. Two cases of neuromyelitis optica spectrum disorder were reported in Brazil in 2018. Ocular presentations are unusual and may represent the prodromal signs of dengue. The mechanism hypothesised for viral replication is intrinsic antibody-dependent enhancement (ADE), which refers to Fcγ receptor-mediated viral amplification. This hypothesis suggests that the internalisation of DENV through the Fcγ receptor inhibits antiviral genes by suppressing type-1 IFN-mediated antiviral responses. Hyperaemia, optic disc swelling, haemorrhage, relative afferent pupillary defect are rare, but important signs found in patients with dengue fever.

Conclusão

DENV infection should be suspected in patients with ocular manifestations, even in the absence of systemic signs, distrusting an immune-mediated presentation of optic neuropathy. Failure to diagnose neuro-ophthalmic manifestations of DENV infection may lead to delayed treatment, further ocular injury, and irreversible vision loss.