Acute macular neuroretinopathy in a patient with acute myeloid leukemia and deceased by COVID-19: a case report

Abstract

Purpose Acute macular neuroretinopathy (AMN) is a visual-deteriorating rare clinical entity with an uncertain etiology. We aimed to report a case of AMN and underlying disease of acute myeloid leukemia (AML). Case presentation A thirty-five-year-old female patient with bone marrow biopsy confirmed AML, and bicytopenia, under chemotherapy, complained of sudden paracentral visual field defect in her right eye was referred. Visual acuity was 20/20 in both eyes. Posterior segment evaluation revealed multiple Roth’s spots. Optical coherence tomography (OCT) demonstrated hyper-reflectivity band, in the outer nuclear layer and outer plexiform layer, nasal to the fovea of the right eye, and hyperreflective patch in outer retina segmentation en-face OCT, suggestive of the diagnosis of AMN. Nine days after AMN diagnosis, dyspnea, malaise, and cough was initiated. Ground glass opacities in lung CT scan, beside reverse transcription polymerase chain reaction of severe acute respiratory syndrome coronavirus-2, was conclusive of coronavirus disease 2019 (COVID-19). The patient deceased after 6 days. Conclusion We report a rare case of AMN following AML. Our findings support the role of ischemia in the outer retina, of which AML may contributed to the pathophysiological process. The patient has deceased less than 2 weeks from AMN initiation.

Pachychoroid Spectrum Disorder Findings in Patients with Coronavirus Disease 2019

“…Either way, regarding the novelty of COVID-19 and its many unknown faces, every practitioner managing these patients should anticipate various clinical pictures and organ system involvement and treat the variable clinical presentations of COVID-19 as a rule and not an exception. Regarding to accumulative evidences on retinal and choroidal changes due to COVID-19 infection in this report and previous reports [ 24 – 28 ], we could propose the COVID-19 infection as a new etiology for pachychoroid spectrum disorder.…”

Acute macular neuroretinopathy associated with COVID-19 infection

“… 2 However, there is a growing literature of retinal vascular manifestations potentially related to COVID-19 including isolated cotton wool spots and retinal microhemorrhages, 3 retinal vein occlusions, 4 , 5 as well as some cases of acute macular neuroretinopathy (AMN) and paracentral middle maculopathy (PAMM). 6 , 7 , 8 Many of the reported AMN and PAMM findings associated with COVID-19 have had somewhat atypical presentations and findings including complicated underlying medical histories, advanced age, and atypical retinal findings including hemorrhages or subretinal fluid.…”

Retinal manifestations in patients following COVID-19 infection: A consecutive case series

“…of cases[ 22 ] In association with COVID-19, there are only two reports so far, one representing post-infectious complication[ 25 ] and another where PAMM was associated with acute myeloid leukemia and co-existing COVID-19 infection. [ 26 ]…”