HEMORRHAGIC-FEVER (PUUMALA-VIRUS INFECTION) WITH OCULAR INVOLVEMENT

Background: Puumala virus infection (nephropathia epidemica) is a dise ase in the group of hemorrhagic fevers with renal syndrome causing ocu lar manifestations, e.g. transient myopia and changes in intraocular p ressure. Patient and methods: Comprehensive and repeated ophthalmic ex aminations of a previously healthy 35-year-old woman with acute Puumal a virus infection were performed. Special attention was paid to ophtha lmic A-scan ultrasound measurements and simultaneous blood chemistry t ests. Results: The ocular manifestations of this patient's illness inc luded transient myopia, low intraocular pressure, conjunctival hemorrh ages and changes of intraocular dimensions. There was forward movement of the anterior diaphragm and thickening of the crystalline lens, whi ch occurred simultaneously with prominent fluctuations in the electrol yte balance, especially potassium. Conclusions: The observed changes i n intraocular dimensions may have been caused by simultaneous fluctuat ions in electrolyte and osmotic balance, which could explain the myopi c shift. The symmetry of the ocular measurements implied a systemic in fection as the underlying reason for the ophthalmic symptoms and signs .