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A patient in her 50s with a history of type 2 diabetes and mild bilateral nonproliferative diabetic retinopathy presented with new-onset floaters in both eyes but no blurry vision, eye pain, or photopsia. This patient was recently discharged from the hospital for West Nile virus (WNV) encephalitis (confirmed seropositive for IgM and IgG antibodies against WNV). Polymerase chain reaction analyses detected no DNA for Epstein-Barr virus, BK virus, cytomegalovirus, or herpes simplex virus types 1 and 2. Neither HIV antibody nor antigen was detected. Cerebrospinal fluid culture analysis findings were normal. She received supportive treatment and made a full recovery.
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West Nile virus chorioretinitis
This patient was diagnosed with WNV chorioretinitis based on the characteristic chorioretinitis lesions observed on clinical examination and diagnostic imaging, which are described below, and the confirmed diagnosis of WNV encephalitis. The most appropriate management is observation. Biopsy of the vitreous or the chorioretinal lesion is unlikely to yield additional diagnostic information, and the invasive procedure places the patient at risk for avoidable complications. Magnetic resonance imaging of the brain is unnecessary because it was recently performed when the patient was hospitalized for WNV encephalitis, and repeating the procedure will not provide additional clinical information.
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Corresponding Author: Hang Pham, MD, Department of Ophthalmology, Saint Louis University Eye Institute, 1755 S Grand Blvd, St Louis, MO 63104 (firstname.lastname@example.org).
Published Online: November 2, 2017. doi:10.1001/jamaophthalmol.2017.3504
Conflict of Interest Disclosures: Both authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
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