Optic neuritis and rapidly progressive necrotizing retinitis as the initial signs of subacute sclerosing panencephalitis: a case report with clinical and histopathologic findings

Optical Coherence Tomography Angiographic Follow-Up in a Case of Subacute Sclerosing Panencephalitis and Unilateral Necrotising Retinitis

We present a 20-year-old woman who was diagnosed with subacute sclerosing panencephalitis (SSPE) 20 months after presenting with unilateral retinitis. At presentation, the patient had two inferotemporal macular lesions in her left eye. Corresponding to these areas, optical coherence tomography (OCT) showed hyporeflective spaces with loss of nearly all of the retinal layers. OCT-angiography (OCTA) demonstrated some flow deficit areas with a reduction in the vessel density. Her serum measles antibody titre was high (IgG >5000.0 mIU/ml). Twenty months later the macular lesions had diminished in size, and there was some focal retinal thinning with interruption of the ellipsoid zone. OCTA showed that the flow deficit areas were diminished in size together with the relatively improved perfusion density. Neurological examination disclosed myoclonic jerks. Neuropsychological assessment demonstrated impaired executive function, attention, and narrowed lexical fluency. Measles IgG antibody was high in the cerebrospinal fluid (>230.0 U/ml). Brain magnetic resonance imaging demonstrated bilateral, non-specific, small foci of T2 hyperintensity in the frontoparietal subcortical white matter and centrum semiovale. The present case is the first where OCTA findings of SSPE-related retinal lesions have been described.

Spectral Domain Optical Coherence Tomography Findings of Subacute Sclerosing Panencephalitis Presenting with Macular Necrotizing Retinitis: A Case Report

PURPOSE

To report the fundus photographs and spectral domain optical coherence tomography (SD-OCT) findings of a patient with subacute sclerosing panencephalitis (SSPE) presenting merely with ocular symptoms.

CASE REPORT

A 20-year-old patient presented with sudden loss of vision in the left eye (LE). Fundus photograph showed a yellow lesion in the macula and SD-OCT showed increased reflectivity of the inner retinal layers. Disorganization of the necrotizing retinal layers in the LE gradually progressed to the atrophic retina. Then, visual complaints began in the right eye (RE) accompanied by neurological symptoms. SD-OCT revealed the inner and outer plexiform layers edema and interruption of the ellipsoid zone in RE. Fundus photographs showed macular atrophy for both eyes on the day patient died.

CONCLUSION

This case report demonstrates the SD-OCT findings of SSPE retinitis with close follow-up from the acute retinitis to the total atrophic macula. These unique findings may be considered as characteristical for the diagnosis.

Retinitis as the presenting feature of subacute sclerosing panencephalitis in an Indian male: A case report

Measles virus is a rare but important cause for acute retinitis as it can eventually lead to the fulminant complication of SSPE. We report a case of a young Indian male with acute viral retinitis who subsequently developed SSPE. It is of paramount importance to consider measles virus and SSPE as a cause in an immunocompetent young adult with necrotizing viral retinitis

BILATERAL SUBRETINAL FLUID AND RETINAL VASCULOPATHY ASSOCIATED WITH SUBACUTE SCLEROSING PANENCEPHALITIS

PURPOSE

To report a case of bilateral retinopathy associated with subacute sclerosing panencephalitis.

METHODS

History and clinical examination, fluorescein angiography, and optical coherence tomography.

RESULTS

We report a rare case of unilateral, followed by bilateral retinopathy, subretinal fluid, and vasculopathy in a young boy. History of missed measles vaccination, behavioral and neurologic symptoms, and electroencephalogram suggested a diagnosis of subacute sclerosing panencephalitis. Retinal imaging using optical coherence tomography was performed to document changes in the retinal microstructure through the natural course of the disease. Within 8 weeks, the changes progressed to retinal atrophy in both eyes.

CONCLUSION

The progressive course of retinitis associated with subacute sclerosing panencephalitis can be monitored on optical coherence tomography. Retinitis is subacute sclerosing panencephalitis rapidly progressive from the acute stage to the stage of atrophy, involving full thickness of the retina.