Bilateral Conjunctivitis in a Returned Traveller

Abstract

A 30-year-old female presented to a tertiary hospital with two weeks of fevers and left upper quadrant abdominal pain after returning from the Gili Islands, Indonesia. She was immunised against hepatitis B, hepatitis A, and typhoid. She did not take malaria prophylaxis and recalls being bitten by insects. Laboratory investigations revealed an elevated C-reactive protein level (158 mg/L), mild thrombocytopenia (148 10^9/L), and deranged liver functions tests. Her malaria smear and blood and urine cultures were negative. Serology for dengue fever, chikungunya, human immunodeficiency virus, hepatitis B, hepatitis C, hepatitis A, leptospirosis, and rickettsia were sent. Two days into the admission, she subsequently developed significant bilateral conjunctivitis and was reviewed by the ophthalmology unit (Fig. Ophthalmoscopy revealed a small, pale, inactive spot on the retina. The lens, macula, and retina otherwise appeared normal. Without antibiotic treatment, the patient's fevers and abdominal pain resolved, although the conjunctivitis worsened (Fig.