# Paracentral Acute Middle Maculopathy Associated With Dengue Fever

## TL;DR

A rare case of paracentral acute middle maculopathy (PAMM) is reported in a patient following dengue fever, highlighting the need for ocular evaluation in such cases.

## Contribution

This case report is one of the few to associate PAMM with dengue fever and suggests a possible link between dengue-induced inflammation and retinal ischemia.

## Key findings

- A 33-year-old male developed PAMM following dengue fever with symptoms including blurred vision and a scotoma.
- OCT imaging showed hyperreflective areas in the inner retina, consistent with PAMM.
- Treatment with prednisolone led to improved visual acuity and reduced retinal lesions.

## Abstract

Newer imaging technique systems have led to an increased interest in the anatomical localization of retinal disease. The clinical and optical coherence tomography (OCT) features of paracentral acute middle maculopathy (PAMM) have been increasingly described and are classically defined by a hyperreflective band at the level of the inner nuclear layer (INL). Symptoms typically include blurred central vision with a paracentral scotoma. Potential causes include retinal vascular diseases and systemic disorders.

We present the clinical and OCT findings of a 33-year-old male patient with PAMM following dengue fever. The patient presented with a five-day history of fever, chills, severe body aches, and a generalized body rash. On day 1, he had undergone a series of investigations to determine the cause, and the test results were positive for dengue fever (Rapid NS antigen 1 45.47 S/Co (positive > 1.0 S/Co). On day five, he noticed bleeding from his gums, which correlated to a drop in his platelet count to 77,000/mm3. At this time, he complained of a scotoma in front of the right eye with mildly blurred vision. His visual acuity was 6/12, N8 in the right eye and 6/6, N6 in the left eye. Slit lamp examination of the anterior segment was normal in either eye. Dilated fundus evaluation revealed multiple grayish-white areas of retinitis in the superior macula with associated hemorrhages. An OCT scan revealed multiple areas of hyperreflectivity in the inner retina, primarily from the inner nuclear and inner plexiform layers. He was treated with oral prednisolone 40 mg/day with tapering every week. At day seven, there was a significant reduction in his symptoms with an increase in the visual acuity to 6/9, N6, and a decrease in the size of the retinal lesions and inner retina hyper reflectivity

A wide spectrum of ocular complications has been described in dengue. Common anterior segment lesions include conjunctival petechiae, subconjunctival hemorrhage, or anterior uveitis. Common posterior segment findings include retinal hemorrhages, posterior uveitis, and several presentations of dengue maculopathy. PAMM following dengue fever has only rarely been reported. We hypothesize that dengue-induced local inflammatory or hemoconcentration processes may have led to deep capillary plexus (DCP) circulatory compromise, leading to ischemia, especially in the area supplied by the DCP. The onset of a central scotoma may suggest the onset of PAMM, and this requires a comprehensive ocular evaluation, and if required, an OCT test to rule out this possibility. Ophthalmologists should be aware of this differential diagnosis.