Paracentral acute middle maculopathy and acute macular neuro
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Ophthalmic complications of COVID-19 are predicted based on prior knowledge of other coronaviruses. Conjunctivitis can be the presenting sign/symptom and its presence correlates with severity. Cotton wool spots and retinal microhemorrhages have also been reported.

A 37-year-old Caucasian female in week 14 of an uncomplicated pregnancy presented with a 1-day history of abrupt onset, faintly colourful, left eye paracentral scotoma. This was 35 days following the onset of a febrile illness with cough and anosmia. SARS-CoV-2 nasopharyngeal swab was not performed during the infection, but subsequently positive serology (IgG) has been confirmed. Past medical history included acephalgic visual migraine aura and right toxoplasma chorioretinitis. OCT changes correlated with the location of the scotoma. A focal area of hyper-reflective change in the inner and outer plexiform layers with inner nuclear layer volume loss was seen consistent with paracentral acute middle maculopathy (PAMM). Blood was normal, including ESR, CRP, lipids, glucose, ANA, and anti-phospholipid antibodies. An electrocardiogram and carotid Doppler ultrasound were normal.

This patient developed PAMM and AMN soon after confirmed SARS-CoV-2 infection and possibly represent postinfectious complications. COVID-19 has been reported in association with acute limb ischemia, stroke, and the so-called “pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 infection”. PAMM and AMN have similar underlying pathophysiology.