Purpose: To describe multimodal imaging findings of acute West Nile virus chorioretinitis.
Methods: Observational case report. Fundus photographs, fluorescein angiography, indocyanine green angiography, and swept-source optical coherence tomography angiography were used to characterize and describe the clinical findings.
Results: A 58-year-old man presented with acute painless vision loss in the right eye. Multimodal imaging demonstrated multifocal pinpoint early-phase hyperfluorescence with late expanding leakage on fluorescein angiography and late hyperfluorescence on indocyanine green angiography. Swept-source optical coherence tomography angiography en face imaging of the ellipsoid zone layer revealed target-like lesions with central hyperreflectivity with surrounding hyporeflectivity. At 4-week follow-up, the chorioretinal lesions now demonstrated greater demarcation of borders with increased pigmentation. At 8-week follow-up, fundus examination revealed multiple target-like lesions with hyperpigmentation centrally surrounded by a hypopigmented rim. Repeat fluorescein angiography demonstrated central hypofluorescence with surrounding hyperfluorescent staining rim prompting workup for West Nile virus, which was later confirmed by laboratory testing. The patient's visual acuity and clinical examination remained stable on subsequent follow-up visits.
Conclusion: Our case highlights multimodal imaging findings in the acute phase of West Nile virus chorioretinitis, which may be crucial to early diagnosis and identification.