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Brief Report
January 10, 2019

Ocular Findings in Yellow Fever Infection

Author Affiliations
  • 1Centro de Estudo da Visão, Juiz de Fora, Minas Gerais, Brazil
  • 2Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil
  • 3Santa Casa de Misericórdia de Juiz de Fora, Department of General Surgery, Juiz de Fora, Minas Gerais, Brazil
  • 4Brazilian Institute of Fight Against Blindness, Assis and Presidente Prudente, São Paulo, Brazil
JAMA Ophthalmol. 2019;137(3):300-304. doi:10.1001/jamaophthalmol.2018.6408
Key Points

Question  Do patients with acute yellow fever infection present with positive ocular findings?

Findings  In this case series, 2 patients with acute yellow fever virus infection presented with bilateral increased choroidal thickness on ocular ultrasonography. One patient, who died after onset of the infection, also presented with bilateral 360° choroidal detachments and yellowish subretinal lesions; the other patient, previously vaccinated for yellow fever virus, presented with bilateral increased retinal venous congestion.

Meaning  Hemodynamic instability or the direct result of viral infection might be associated with the positive ocular findings in these patients with yellow fever virus.


Importance  Yellow fever virus (YFV) is a reemerging, potentially lethal arboviral disease that has been occurring recently in Africa and South America. Poor levels of immunization have facilitated the viral spread in southeastern Brazil, leading to an unprecedented outbreak that started in late 2016. Although human cases have been linked to sylvatic mosquitoes, the concern is that YFV may spread to urban centers infested with Aedes aegypti and Aedes albopictus mosquitoes and start a true urban cycle.

Objective  To describe the ocular findings in patients with acute YFV infection.

Design, Setting, Participants  Two adults with an acute YFV infection in southeastern Brazil underwent an ophthalmologic and ocular ultrasonographic examination in early 2018.

Main Outcomes and Measures  Ocular findings in patients with acute YFV infection.

Results  Both patients presented with increased choroidal thickness bilaterally seen on ocular ultrasonography. A man in his late 50s who had not been vaccinated previously also presented with bilateral, midperipheral, 360° choroidal detachment and yellowish subretinal lesions. After clinical deterioration and liver transplant, the man died. A woman in her early 30s who had been vaccinated previously for YFV presented with increased retinal venous congestion bilaterally. She was discharged with mild conjunctival chemosis and icterus.

Conclusions and Relevance  These reports describe different patterns of ocular findings associated with YFV acute infection. However, the exact mechanism involved in the retinal and choroidal findings remains unclear.

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