Unilateral frosted branch angiitis in an human immunodeficiency virus-infected patient with concurrent COVID-19 infection: a case report

Abstract

Background Frosted branch angiitis (FBA) is an uncommon ocular sign with multiple causes. With the recent outbreak of coronavirus disease 2019 (COVID-19), many cases of ocular manifestation in association with this disease have been reported. However, as yet we have no complete understanding of this condition. We report here the first case of FBA in a human immunodeficiency virus-infected patient with coexisting cytomegalovirus (CMV) and COVID-19 infection. Case presentation A 33-year-old Malay man with underlying acquired immunodeficiency syndrome receiving highly active antiretroviral therapy was referred to the Opthalmology Department with complaints of blurry vision for the past 2 months. He had tested positive for and been diagnosed with COVID-19 1 month previously. Clinical examination of the fundus revealed extensive perivascular sheathing of both the artery and vein suggestive of FBA in the right eye. Laboratory testing of nasal swabs for COVID-19 polymerase chain reaction (PCR) and serum CMV antibody were positive. The patient was then admitted to the COVID-19 ward and treated with intravenous ganciclovir. Conclusion Clinicians should be aware of and take the necessary standard precautions for possible coexistence of COVID-19 in an immunocompromised patient presenting with blurred vision, eye redness, dry eye and foreign body sensation despite the absence of clinical features suggestive of COVID-19. Whether FBA is one of the ocular signs of co-infection of COVID-19 and CMV remains unknown. Further studies are needed to provide more information on ocular signs presented in patients with concurrent COVID-19 and CMV infections.

Frosted Branch Angiitis in the Setting of Active COVID-19 Infection and Underlying Mixed Connective Tissue Disease

“…It is possible that the combination of her viral illness and underlying autoimmune milieu resulted in her FBA. To our knowledge, there is only two other cases of FBA following COVID-19 illness, the first reported in which FBA arose after a co-infection with CMV in a patient with underlying human immunodeficiency virus [ 4 ]. Our patient had neither positive serologies for CMV or human immunodeficiency virus.…”

“…There have been two reported cases of FBA involving COVID-19 in the literature, the first of which involved a 33-year-old, human immunodeficiency virus-infected patient with coexisting cytomegalovirus (CMV) and COVID-19 infection [ 4 ], and the second involving a child with isolated COVID-19 illness and no other relevant medical history [ 5 ]. Patients reported to have FBA following viral infection often fall into a bimodal age distribution, where there is a peak in early childhood and another in the second or third decade of life [ 3 ].…”

Frosted branch angiitis presenting after a SARS-CoV-2 infection

“…There are reports of more serious involvement related to COVID-19, such as cases of unilateral retinal vasculitis and retinal vein occlusion [12][13][14]. However, the literature currently has only one reported COVI9-19 linked case of frosted angiitis, which occurred in an immunocompromised patient with positive CMV serologies [15].…”

Angeítis de rama congelada en un paciente positivo al virus de la inmunodeficiencia humana con retinitis por citomegalovirus

“…Un patógeno infeccioso vírico actual que se relaciona con la retinitis por CMV con angeítis de rama congelada es el SARS-CoV-2 (18). Lim y col. ( 18) describieron un paciente infectado por VIH con angeítis/angitis congelada unilateral por CMV e infección por SARS-CoV-2 coexistentes (18). Se debe destacar que el paciente en cuestión se encontraba recibiendo terapia antirretroviral de gran actividad, como el paciente que describimos en otro artículo (19).…”

“…Con ello, se puede extraer la lección de que los médicos deben estar preparados y tener en cuenta la posible la coexistencia de SARS-CoV-2 en un paciente VIH que presente sintomatología ocular, como enrojecimiento ocular, ojo seco, visión borrosa y sensación de cuerpo extraño, a pesar de la ausencia de características clínicas que sugieran el diagnóstico de la COVID-19 (18).…”