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A Case of Post-COVID-19-Associated Paracentral Acute Middle Maculopathy and Giant Cell Arteritis-Like Vasculitis

Go L Jonathan1, Fair M Scott, Kay D Matthew

  • 1Department of Ophthalmology, Larkin Community Hospital, South Miami, Florida.

Journal of Neuro-Ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society
|August 20, 2021
PubMed

Insights

COVID-19 may trigger both small and large vessel vasculitis in the eye. This case report details a patient experiencing paracentral acute middle maculopathy and symptoms suggestive of giant cell arteritis following SARS-CoV-2 infection.

Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Rheumatology

Background:

  • COVID-19 has been linked to various neurological and vascular complications.
  • Vasculitis, inflammation of blood vessels, can affect different sizes of vessels throughout the body.
  • Ophthalmic manifestations of post-COVID-19 complications are increasingly reported.

Observation:

  • A 47-year-old male presented with visual disturbances (scotoma) in his right eye, diagnosed as paracentral acute middle maculopathy (PAMM).
  • Two months post-COVID-19 infection, he developed new symptoms including temporal headache and jaw claudication, concerning for giant cell arteritis (GCA).

Findings:

  • The patient's symptoms resolved rapidly within 24 hours of initiating high-dose steroids.
  • Despite clinical suspicion for GCA, inflammatory markers (ESR, CRP) and temporal artery biopsy were normal, likely due to delayed testing after steroid treatment.

Implications:

  • This case potentially represents the first documented instance linking COVID-19 to both small vessel (PAMM) and large vessel (suspected GCA) vasculitis affecting the eye.
  • Further research is warranted to understand the mechanisms and prevalence of COVID-19-associated vasculitis in ophthalmic patients.
  • Early recognition and management of potential vasculitic complications post-COVID-19 are crucial for preserving vision.

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