QUININE TOXICITY: MULTIMODAL RETINAL IMAGING AND ELECTRORETINOGRAPHY FINDINGS.
OBJECTIVE
To report the multimodal retinal imaging and electroretinography (ERG) findings of two cases with quinine toxicity.


METHODS
Retrospective case series describing the retinal imaging and ERG findings in two patients with retinal toxicity due to remote quinine exposure. Color fundus photography, fundus autofluorescence, spectral domain optical coherence tomography, and full-field ERG findings are described.


RESULTS
Two patients with longstanding decreased vision were found to have bilateral optic disk pallor and retinal vascular attenuation indicative of chronic sequela after acute quinine toxicity. Inner retinal atrophy was identified on spectral domain optical coherence tomography, and full-field ERG was consistent with generalized inner retinal dysfunction in both patients. Fundus autofluorescence failed to demonstrate any evidence of outer retinal or retinal pigment epithelial abnormalities.


CONCLUSIONS
Quinine toxicity may be associated with vision loss secondary to inner retinal atrophy. We report two cases with a clear history of acute quinine exposure leading to similar retinal imaging findings and distinctive ERG abnormalities. Clinicians should be aware of this uncommon condition as ingestion history may be remote.
*Retinal Disorders and Genetics Division, Stein Eye Institute, University of California, Los Angeles, California; †Moorfields Eye Hospital, London, United Kingdom; ‡UCL Institute of Ophthalmology, London, United Kingdom; and §Greater Los Angeles VA Healthcare Center, Los Angeles, California.
Daniel
D
Su
Anthony G
AG
Robson
David
D
Xu
Susan
S
Lightman
David
D
Sarraf
D000962:Antimalarials / Q000009:adverse effects*; D004596:Electroretinography; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D010781:Photography; D011803:Quinine / Q000009:adverse effects*; D012164:Retinal Diseases / Q000139:chemically induced* / Q000175:diagnosis*; D041623:Tomography, Optical Coherence
D000962:Antimalarials; D011803:Quinine