Visual loss associated with influenza A: a case report and review of literature

A 24-year-old female presenting with influenza A pneumonia and simultaneous visual loss was hospitalized. A complete ophthalmological examination was performed three weeks later. Best corrected visual acuity was 20/70 (right eye) and 20/30 (left eye). A dilated fundus exam revealed bilateral vitreous cells and marked bilateral optic nerve swelling with associated peripapillary hemorrhages. A submacular hemorrhage was seen in the right eye. Spinal tap opening pressure was 490 mmHg, with normal cerebrospinal fluid cell counts. Eight months after the initial clinical presentation, the patient was asymptomatic, with normal posterior poles and a best corrected visual acuity of 20/30 in the right eye and 20/25 in the left eye. Although papilledema can produce peripheral retinal hemorrhages secondary to extensive retinal venous congestion, the presence of bilateral vitritis and elevated influenza serum titers suggested that the patient might be suffering from influenza retinopathy. Vitreous polymerase chain reaction could potentially aid in the diagnosis of influenza retinopathy.