title: Bilateral vaso-occlusive retinal vasculitis with h1n1 influenza a infection.
abstract: OBJECTIVE
  The purpose of this study is to report a unique case of vaso-occlusive retinal vasculitis in the setting of H1N1 influenza A.
  
  
  METHODS
  This study includes ophthalmologic examination, fluorescein angiogram, optical coherence tomography, neuroimaging, cerebral spinal fluid analysis, serologies, chart review, and review of the relevant literature.
  
  
  RESULTS
  A 13-year-old Caucasian female presented with bilateral vision loss accompanied by mental status changes and flu symptoms. Fundus examination revealed bilateral disk edema, peripapillary and macular flame hemorrhages, macular edema, and cherry-red spots. Fluorescein angiogram revealed vaso-occlusive vasculitis resulting in poor perfusion of the maculae. There was also staining of the optic nerves bilaterally. Optical coherence tomography revealed bilateral macular edema with intraretinal and subretinal fluid.
  
  
  CONCLUSIONS
  This is a unique case of H1N1 influenza A presenting with vaso-occlusive retinal vasculitis, encephalitis, and flu symptoms. The poor vision is not entirely accounted for by the macular disease. Given the accompanying disk edema, there is likely a similar vaso-occlusive process of the central nervous system that contributed to the bilateral light perception vision.
authors.affiliation: *Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan; †Department of Pediatric Critical Medicine, Beaumont Health System, Royal Oak, Michigan; and ‡Associated Retinal Consultants P.C., Department of Vitreoretinal Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan.
authors.forename: Albert Y
authors.initials: AY
authors.lastname: Cheung
authors.forename: Bradley
authors.initials: B
authors.lastname: Anderson
authors.forename: Lori
authors.initials: L
authors.lastname: Stec
authors.forename: Paras
authors.initials: P
authors.lastname: Khandhar
authors.forename: George A
authors.initials: GA
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D004279:DNA, Viral / Q000032:analysis*; D003937:Diagnosis, Differential; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000235:genetics*; D007251:Influenza, Human / Q000150:complications* / Q000821:virology; D031300:Retinal Vasculitis / Q000175:diagnosis / Q000209:etiology*; D012170:Retinal Vein Occlusion / Q000175:diagnosis / Q000209:etiology*; D041623:Tomography, Optical Coherence; D014792:Visual Acuity
chemical_list: D004279:DNA, Viral