Acute viral maculopathy linked with hand, foot, and mouth disease
April 11, 2017
The patient noticed the symptoms while suffering from fever secondary to hand, foot, and mouth disease.
A 29-year-old white male was referred with recent onset central vision loss in the right eye for one week. The patient noticed the symptoms while suffering from fever secondary to hand, foot, and mouth disease.
Other medical and past ocular history was unremarkable other than contact lens wear for myopia.
Optical coherence tomography (OCT) was remarkable for alteration of the outer retina. Note the changes in the retinal pigment epithelium (RPE) and photoreceptor region in an approximately 3000 µm radius around the fovea (see Figure 2).
This patient has suffered acute viral maculopathy in the right eye.
Hand, foot, and mouth (HFM) disease is a condition caused by an enteroviruses most commonly coxsackievirus A16.1 HFM affects humans and should not be confused for foot-and-mouth (or hoof-and-mouth disease), which affects cloven-hoofed animals such as pigs and cows and is not a human disease.
The virus is usually spread by sneezing and coughing by the carrier or through oral secretions or blister fluid. Although most affected are young children, adults can be afflicted by the disease.
Typical symptoms include:
• Sore throat
• Loss of appetite
• Painful oral cavity blisters
• Red rash without itching affecting palm of the hand, sole of the foot, and sometimes buttocks
Systemic complications include viral meningitis and encephalitis.
There is no specific therapy other than supportive treatment of symptoms.1,2
Acute viral maculopathy has been reported associated with HFM. In most cases, the condition is unilateral.
Initially, a circular area of mild gray discoloration of the macula may be noted followed by granular hyperpigmentation of the retinal pigment epithelium. The condition may present in one or both eyes.
There is no recommended treatment for HFM itself, and the condition is self-limiting.1
The use of systemic corticosteroids is controversial;3,4 however, Agrawal et al reported visual improvement in their presented case.4
Steroid therapy was not considered in this case because the patient had presented well beyond the acute phase of the disease with the expected outcome of profound vision loss.