Bilateral ampiginous choroiditis after COVID-19: a report of two cases

TL;DR

Two patients developed bilateral ampiginous choroiditis after recovering from COVID-19, suggesting a possible link between the virus and eye inflammation.

Contribution

This paper reports two new cases linking post-COVID-19 recovery to ampiginous choroiditis, suggesting a potential immunogenic trigger.

Findings

Two patients with recent COVID-19 infections developed bilateral ampiginous choroiditis.

Multimodal imaging confirmed the diagnosis in both patients.

Treatment with oral steroids and azathioprine was initiated in both cases.

Abstract

Ampiginous choroiditis is a disease that includes features of both acute posterior multifocal placoid pigment epitheliopathy and serpiginous choroiditis. This article presents two patients who were diagnosed with ampiginous choroiditis in our clinic. A 28-year-old female patient presented to our clinic with blurred vision that had persisted for 2 weeks. Her best corrected visual acuity (BCVA) was 20/20. Her medical history included a COVID-19 infection about 1 month before. Fundoscopic examination revealed multiple grayish-yellow lesions with irregular borders and pseudopodial extensions, involving the posterior poles of both eyes diffusely. Fundus findings and multimodal imaging, including optical coherence tomography, fundus autofluorescence imaging, and fundus fluorescein angiography, indicated ampiginous choroiditis. The patient was treated with oral steroids and azathioprine. The second patient was a 34-year-old male under follow-up in the neurology clinic, with a diagnosis of transverse myelitis, who was referred to us for an ophthalmologic consultation. The patient had a COVID-19 infection a few weeks prior. The patient had no visual symptoms in our first examination, and his BCVA was 20/20. Fundus examination and multimodal imaging were associated with ampiginous choroiditis. The patient’s ongoing treatment was initiated by neurology, including oral steroids and azathioprine therapy. This treatment regimen was continued, and follow-up was conducted. In conclusion, these two cases suggest that the SARS-CoV-2 virus may serve as an immunogenic trigger for the development or reactivation of ocular inflammatory diseases in individuals predisposed to white dot syndromes.

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