P 400
Ocular symptoms in epidemic nephropathy
A. H. Heuring1,2, W. W. Hütz2, H. B. Eckhardt2
Background: Epidemic nephropathy (NE) is caused by Puumala virus, a virus belonging to the Hantavirus family. The main reservoir is the bank vole. Transmission is mainly through the respiratory pathway by dust contaminated by rodent excreta. The disease begins with an acute fever with headache and myalgia. After 4 10 days the patient develops a tubular and interstitiell nephritis with oliguria or anuria followed by a polyuric phase. Extrarenal symptoms are meningoencephalitis, carditis, hepatitis, but also ocular changes like lid edema, conjunctival injection, hemorrhages, chemosis, iritis, anisocoria, diplopia, retinal edema and changes in intraocular pressure (IOP) have been described. However, the most obvious ophthalmic manifestation is transient myopia, which the patient realizes as a loss of visual acuity.
Case report: A 41-year old male developed high fever with associated cephalgia. Two days after hospitalization the patient had a renal manifestation with proteinuria and hematuria. During this period an acute infection with the Puumala virus was confirmed serologically. A few days after hospitalization the patient observed blurring of vision on his left eye: uncorrected visual acuity was 20/20 OD and 8/12 OS with a myopic refraction of 3,25 D. There was no hint of myopia previously. 3 days later visual acuity was increased to 16/20 with 2,5 D and after 3 weeks the patient regained full uncorrected visual acuity of 20/20. Slit lamp examination revealed a shallow anterior chamber confirmed by ultrasound measurement. A-scan ultrasound revealed a foreward movement of the iris and lens diaphragm caused by an intensive chorioidal effusion (seen on B-scan ultrasound). Moreover the cristalline lens had an increased thickness compared to the fellow eye. According to the reduction of the myopia these alterations were decreased in the convalescent period and had disappeared after three weeks.
Conclusion: Ophthalmologic complications of epidemic nephropathy are not unusual, the more impressive. Although the observed changes were unilateral, the systemic infection with its intensive fluctuations in electrolyte and osmotic balance should be reasonable for the described alterations.
1
Department of Ophthalmology, Otto von Guericke University Magdeburg, Germany