In the Eye of the Cytokine Storm: A Tale of SARS-CoV-2-Induced Acute Macular Neuroretinopathy

• Published in: Curēus (Palo Alto, CA) Vol. 15; no. 3; p. e36797
• Main Authors: Reddy, Sujana, Garvin, Alizah, Weeks, Jeffrey L, West, Matthew R
• Format: Journal Article
• Language: English
• Published: United States Cureus Inc 28.03.2023; Cureus
• Subjects: Coronaviruses; COVID-19 vaccines; Females; Immunization; Infections; Infectious Disease; Influenza; Internal Medicine; Ischemia; Medical research; Ophthalmology; Pandemics; Polymerase chain reaction; Retina; Risk factors; Severe acute respiratory syndrome coronavirus 2; Steroids; Visual acuity; microvascular; oct (optical coherence tomography); cytokine storm; optical coherence tomography; acute macular neuroretinopathy; covid-19; cytokine storm syndrome; covid-19 pandemic; sars-cov-2
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.36797

Acute macular neuroretinopathy (AMN) commonly affects young to middle-aged females and is considered a relatively rare retinal disease, and the etiology is complex. Advances in multimodal imaging provide a better characterization of retinal disorders and have helped identify that one of the etiologies of AMN is microvascular in nature. This case is clinically relevant as it adds to the literature that the pathophysiology of AMN is vascular-driven. Our case is a 24-year-old Black female with no past medical history, the only medication she was taking was an oral contraceptive pill, who presented to the emergency room with a 24-hour history of left central field vision loss and endorsed a recent upper respiratory tract infection preceding the acute vision loss. It was subsequently found on admission that the patient tested positive for and had a SARS-CoV-2 infection. A retina specialist performed optical coherence tomography (OCT), which showed disruption in the outer segment junction, including the ellipsoid zone and outer plexiform. The use of multimodal imaging like OCT helped confirm AMN; therefore, prompt examination by ophthalmology is critical to confirm a correct diagnosis. This patient's vision improved and remained stable five months later. This case demonstrates that, like other viruses, SARS-CoV-2 has the potential to cause retinal disease complications such as AMN. These findings reinforce and add to the current literature that SARS-CoV-2 can cause multiple-organ system dysfunction at a vascular level through immune-mediated pathways.