Case Report: Acute Macular Neuroretinopathy Which Led to COVID-19 Infection Diagnosis

Abstract

We present a case of Acute Macular Neuroretinopathy (AMN), which led to the coronavirus disease of 2019 (COVID-19) infection diagnosis. A 27-year-old female patient with flu-like symptoms later proven to be COVID-19 infection presented with acute-onset bilateral gray-like paracentral scotomas. Fundus examination showed a hypopigmented, wedge-like lesion on the superior temporal juxtafoveal area in the right eye, while no significant finding was found in the left eye. Infrared reflectance images demonstrated bilateral hyporeflective lesions in the parafoveal regions of the macula. Spectral-domain optical coherence tomography scans over the corresponding areas detected focal hyperreflectivity in the outer nuclear layer with disruption in the ellipsoid zone and retinal pigment epithelium layers. Based on these findings, the AMN diagnosis was considered. The COVID-19 infection diagnosis was confirmed by a polymerase chain reaction test. COVID-19 disease may cause retinal vascular complications such as AMN. AMN, which shares common viral prodromal symptoms with COVID-19 infection, may be a presenting sign of COVID-19 infection.