title: A UNIQUE POSTERIOR SEGMENT PHENOTYPIC MANIFESTATION OF COXSACKIE VIRUS INFECTION.
abstract: OBJECTIVE
  To report a posterior segment phenotypic manifestation of Coxsackie virus infection that has not been previously appreciated.
  
  
  METHODS
  The clinical course and multimodal imaging findings, including spectral domain optical coherence tomography, fluorescein angiography, near infrared reflectance, and fundus autofluorescence of two patients with Coxsackie virus infections were documented.
  
  
  RESULTS
  A neurosensory macular detachment was present in both patients on baseline examination. Fluorescein angiography demonstrated pooling within this lesion and spectral domain optical coherence tomography identified thickening of the retinal pigment epithelial band with variable degrees of attenuation of the ellipsoid zone and interdigitation zone. Fundus autofluorescence and near infrared reflectance imaging revealed multiple satellite lesions adjacent to the neurosensory detachment. These lesions were not seen on fluorescein angiography or color photography. Satellite lesions were hyporeflective on near infrared reflectance imaging and hyperautofluorescent on fundus autofluorescence imaging. The satellite lesions correlated with sites of ellipsoid disruption on spectral domain optical coherence tomography. Both patients were observed and their condition improved over the course of time. There was total resolution of satellite lesions, reconstitution of the ellipsoid zone and interdigitation zone, and return of retinal pigment epithelial thickness to the normal range. A bull's eye pattern of macular retinal pigment epithelial disturbance persisted on color and near infrared reflectance images, despite good visual acuity.
  
  
  CONCLUSIONS
  Posterior segment Coxsackie virus infection may concurrently express the clinical characteristics of acute idiopathic maculopathy and multifocal retinitis. The visual prognosis in this variant is usually favorable. The multimodal imaging features that characterize this entity should be recognized to avoid confusion with other diseases that have a similar presentation.
authors.affiliation: *Vitreous-Retina-Macula Consultants of New York, New York, New York; †The LuEsther T. Mertz Retinal Research Center, New York, New York; ‡Department of Physiology and Pharmacology, Centre for Ophthalmology and Visual Sciences, Lions Eye Institute, University of Western Australia, Perth, Australia; §Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, Massachusetts; ¶New York Eye and Ear Institute, New York, New York; **Good Samaritan Hospital, Suffern, New York, New York; ††Rockland Retina, New City, New York; ‡‡Department of Ophthalmology, New York University School of Medicine, New York, New York; and §§Manhattan Eye, Ear and Throat Hospital/Northshore Long Island Jewish Hospital, New York, New York.
authors.forename: Chandrakumar
authors.initials: C
authors.lastname: Balaratnasingam
authors.forename: David R
authors.initials: DR
authors.lastname: Lally
authors.forename: Kirstin L
authors.initials: KL
authors.lastname: Tawse
authors.forename: Louis
authors.initials: L
authors.lastname: Maisel
authors.forename: K Bailey
authors.initials: KB
authors.lastname: Freund
authors.forename: Nadia K
authors.initials: NK
authors.lastname: Waheed
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Yannuzzi
mesh_terms: D000293:Adolescent; D003384:Coxsackievirus Infections / Q000473:pathology*; D015828:Eye Infections, Viral / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D064847:Multimodal Imaging; D010641:Phenotype; D057972:Posterior Eye Segment / Q000473:pathology / Q000821:virology; D012163:Retinal Detachment / Q000473:pathology*; D012173:Retinitis / Q000473:pathology; D055815:Young Adult