Ocular flutter following Zika virus infection
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CASE REPORT
Ocular flutter following Zika virus infection Emely Karam 1 & Jose Giraldo 2 & Flor Rodriguez 3 & Carlos E. Hernandez-Pereira 4,5 & Alfonso J. Rodriguez-Morales 6,7 & Gabriela M. Blohm 8 & Alberto E. Paniz-Mondolfi 9,10,11
Received: 20 June 2017 / Revised: 15 September 2017 / Accepted: 27 September 2017 # Journal of NeuroVirology, Inc. 2017
Abstract Zika virus (ZIKV) is an emerging flavivirus which has been linked to a number of neurologic manifestations such as Guillain-Barré syndrome (GBS), transverse myelitis, and meningo-encephalitis. Ophthalmologic manifestations are increasingly being reported; however, ocular dyskinesias have not been described in this context to date. Herein, we report a case of a 22-year-old female who presented with ocular flutter and associated Guillain-Barré syndrome following acute ZIKV infection. We speculate that although such symptoms may have originated from a direct viral insult, a postinfectious autoimmune mechanism may not be excluded. Physicians should include ZIKV as well as other flaviviruses in their diagnostic workup for all patients with ocular flutter/ opsoclonus, after excluding other non-infectious causes of central nervous system pathology. To the best of our knowledge, this is the first report on the association of ocular flutter, GBS, and ZIKV infection.
Keywords Zika virus . Ocular flutter . Viral . Guillain-Barré syndrome
A 22-year-old woman developed fever, malaise, arthralgia, cough, and generalized maculopapular rash lasting 6 days. Past medical history was significant for Hashimoto’s thyroiditis with no exposure to sick contacts, pets/animals, or recent travel. A week after the acute onset of symptoms, she developed symmetrical weakness and numbness of the upper limbs which progressed to all four extremities associated with generalized lymphadenopathy, anorexia, diaphoresis, and myalgias. Her condition worsened developing seizures and hypotension 2 weeks after; followed by subacute onset of dizziness, dysarthria, photophobia, and episodes of blurred vision with abnormal ocular movements.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s13365-017-0585-1) contains supplementary material, which is available to authorized users. * Alberto E. Paniz-Mondolfi [email protected]; [email protected]
6
Colombian Collaborative Network on Zika (RECOLZIKA), Pereira, Risaralda, Colombia
7 1
Department of Ophtalmology, Centro Médico Docente La Trinidad, Caracas, Venezuela
Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnologica de Pereira, Pereira, Colombia
8
2
Department of Ophtalmology, Hospital Internacional Barquisimeto, Barquisimeto, Lara, Venezuela
Department of Biology, College of Liberal Arts and Sciences, University of Florida, Gainesville, FL, USA
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3
Department of Ophtalmology, Grupo Médico La Sagrada Familia, Lechería, Anzoategui, Venezuela
Department of Infectious Diseases and Tropical Medicine, Hospital Internacional Barquisimeto,
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