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Case Reports: Unusual association of diseases/symptoms
Paracentral acute middle maculopathy in Susac syndrome after dual exposure to SARS-CoV-2 antigen
  1. Fernando Korn Malerbi1,
  2. Vinicius Andreoli Schoeps2 and
  3. Kimble T F Matos3
  1. 1Department of Ophthalmology and Visual Sciences, Federal University of Sao Paulo, Sao Paulo, Brazil
  2. 2Neurology Division, Universidade de São Paulo, Sao Paulo, Brazil
  3. 3Opthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil
  1. Correspondence to Dr Kimble T F Matos; Kimblematos{at}hotmail.com

Abstract

We report a case of Susac syndrome after SARS-CoV-2 infection and subsequent vaccination that presented with meningitis and retinal microembolisation in the form of paracentral acute middle maculopathy (PAMM). After presenting with headache, fever and myalgia followed by scotomata, a woman in her 50s was hospitalised for meningitis; she had had mild COVID-19 infection 2 months prior to admission, having received the first vaccine dose 1 month prior to the neurological manifestation. Eye fundus examination and optical coherence tomography were suggestive of PAMM. D-dimer levels and erythrocyte sedimentation rate were elevated. Before infectious investigation results were available, she was started on empirical antibiotic and antiviral treatment. Having ruled out infectious causes, she was started on high-dose prednisolone. After 1 month, there was partial resolution of retinal lesions. This case highlights that exposure to SARS-CoV-2 antigen may be related to this rare syndrome; treatment with steroids may improve central and retinal impairment.

  • COVID-19
  • Retina
  • Neurology
  • Vaccination/immunisation
  • Ear, nose and throat/otolaryngology

https://doi.org/10.1136/bcr-2021-247159

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    Footnotes

    • Contributors Supervised by KM. The patient was under the care of KM. FKM, VAS and KM contributed equally in the planning, design, data acquisition and interpretation, and in the writing of the report.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.