Presumed enterovirus-associated bilateral asymmetrical retinitis with haemorrhagic occlusive retinal vasculitis secondary to hand, foot and mouth disease

A female toddler clinically diagnosed with hand, foot and mouth disease (HFMD) was referred by the treating paediatrician, with acute-onset painless diminution of vision for 3 days. She had papulomacular skin rashes and was unable to follow the light stimulus at presentation. On fundus evaluation, bilateral asymmetrical (left eye more severe than the right eye) multifocal full-thickness necrotising retinitis, occlusive haemorrhagic retinal vasculitis, optic disc pallor and left eye exudative retinal detachment (eRD) were noted. Due to the background of HFMD and unexpected prompt response of intravitreal and systemic corticosteroids, a preliminary diagnosis of bilateral presumed enterovirus-associated retinopathy was established. The patient showed a favourable response to a weekly taper of oral steroids for the next 3 months. The retinitis, vasculitis and eRD were resolved with widespread retinal pigment epithelium (RPE) atrophy. HFMD with retinopathy secondary to presumed enterovirus infection, though rare, can present with extensive RPE and optic disc atrophy despite administration of oral corticosteroids.