OSLI Retina

September 2020

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September 2020 · Vol. 51, No. 9 529 ■ C A S E R E P O R T ■ The Expanded Clinical Spectrum of Coxsackie Retinopathy Stephanie J. Weiss, DO; Kyle Kovacs, MD; Luis A. Gonzalez-Gonzalez, MD, MPH; Aristomenis Thanos, MD; David Sarraf, MD; Dean Eliott, MD; Donald J D'Amico, MD; Thanos D. Papakostas, MD ABSTRACT: The authors present two cases of cox- sackie retinopathy that presented with the clas- sic findings of acute outer retinal disruption that evolved to an outer retinal scar. In these two cases, the classic lesions displayed an extramacular dis- tribution. The authors provide detailed multimodal imaging in both cases highlighting the nature of the lesions. It is important to consider coxsackie virus infection in the differential diagnosis of extramacu- lar lesions with outer retinal disruption. The term "unilateral acute idiopathic maculopathy" should be replaced with "coxsackie retinopathy" to better align with the expanded clinical spectrum and the known etiology of this disorder. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:529-532.] INTRODUCTION Hand, foot, and mouth disease caused by coxsack- ie virus has been associated with a number of sys- temic and ocular manifestations. Systemically, hand, foot, and mouth disease presents with a maculopapu- lar rash on the palms and soles, oral lesions, and a flu-like viral prodrome. 1 Ocular manifestations are rare. Acute idiopathic maculopathy (AIM) is most common and presents with an exudative macular detachment. 2-5 Panuve- itis, retinal vasculitis, outer retinitis, and chorioreti- nitis are less common manifestations that have been associated with coxsackie virus and hand, foot, and mouth disease. 6-9 Herein, we present a novel presen- tation of coxsackie virus infection associated with the development of extramacular peripapillary or midpe- ripheral outer retinal lesions in two patients. CASE REPORTS Case 1 A 42-year-old man presented with a peripheral scotoma in the left eye for 2 weeks. Three weeks pri- or to the development of the scotoma, the patient's two daughters developed fevers associated with skin lesions on their legs. Two days later the patient de- veloped fevers and an oral lesion that lasted for 24 hours and then completely resolved. On presenta- tion, visual acuity (VA) was 20/15 in the right eye (OD) and 20/20 in the left eye (OS). Anterior segment examination and intraocular pressures (IOPs) were From Retina Service, Department of Ophthalmology, Weill Cornell Medical College, New York, New York (SJW, KK, LG, DJD, TDP); Retina Service, Devers Eye Institute, Portland, Oregon (AT); Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, UCLA, Los Angeles, California (DS); and Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts (DE). Originally submitted May 5, 2020. Revision received May 5, 2020. Accepted for publication July 9, 2020. Presented at the Atlantic Coast Retina Club in January 2019 in Boston, Massachusetts. The authors report no relevant financial disclosures. Address correspondence to Thanos D. Papakostas, MD, Retina Service, Department of Ophthalmology, Weill Cornell Medical College, New York, NY; email: thp9034@med.cornell.edu. doi: 10.3928/23258160-20200831-08

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