Poster David Martins

Objective:

Description of a clinical case with scientific interest.

Introduction:

Bilateral amaurosis is a rare complication of the treatment of Plasmodium falciparum malaria with quinine, and can occur with a single therapeutic dose in susceptible individuals. Visual acuity recovery usually occurs, with restricted visual field, but in a few cases amaurosis may be permanent, with optic atrophy.

Case Study:

35 year-old male, smoker and healthy to date. Five days after returning from Angola he was admitted with the diagnosis of Plasmodium falciparum malaria and initiated therapy with Quinine Dihydrochloride IV, initially 1 gram and then 500 mg tid, and Doxycycline IV, 100 mg bid, which continued for 9 days. On the fourth day he had an episode of acute respiratory distress syndrome and cardiorespiratory arrest, was intubated and remained in an induced coma for 5 days. When coma was suspended he complains of severe decrease in visual acuity. The first observation revealed no light perception, pupils were fixed in mydriasis, photomotor reflexes were absent and remaining neurological examination was normal. In the ocular fundus, light pallor of the papillae, without retinal edema and without chorioretinitis were observed. CT and MRI of brain and orbits were normal. Fourteen days after, still showed bilateral amaurosis, fixed pupils in mydriasis, IOP of 13 mmHg, and the ocular fundus had pale optical discs and generalized arterial narrowing. The first VEP Flash, showed increased latency of the P wave bilaterally. Ten days later there were no cortical potentials (P100) bilaterally. OCT showed atrophy of all retinal layers and ERG-Flash demonstrated markedly reduced bioelectrical activity of the inner and medium retinal layers on both eyes.

Conclusions:

In this case there was no visual acuity recovery. Visual loss by quinine treatment depends on the knowledge of the location and mechanism of toxicity, which have been subject of discussion and controversy for a long, and currently there is no proven and effective therapy for the disease.