Abstract
Purpose
To report a case of bilateral acute macular neuroretinopathy (AMN) occurring in a 32-year-old woman, analyzed using the multimodal imaging technique.
Case report
A 32-year-old Caucasian woman presented with 20 days history of acute onset of blurred vision in the right eye. The best-corrected visual acuity (BCVA) was 0.8 and 1.0 in the right and left eyes, respectively. She reported a lower urinary tract infection associated with fever, 7 days before the onset of the ocular symptoms. Serological tests demonstrated the presence of IgM specific for cytomegalovirus (CMV), while all the other laboratory tests were negative. SD-OCT exhibited the disruption of the inner segment–outer segment junction, associated with hyper-reflectivity of a thickened outer plexiform layer overlying such area associated with thinning of the outer nuclear layer. The patient was diagnosed with AMN and received a corticosteroid treatment. During all the follow-up, OCT features did not change, although BCVA improved. Four months after the first visit, we found also in the left eye a subfoveal IS/OS disruption but differently from the right eye, in which the abnormalities persisted during all the follow-up visits, in the left one they disappeared only after a month. The IgM specific for the CMV remained positive during the whole follow-up.
Conclusions
To our knowledge, this is the first patient reported with a diagnosis of AMN associated with persisting presence of IgM specific for CMV.
References
Bos PJ, Deutman AF (1975) Acute macular neuroretinopathy. Am J Ophthalmol 80:573–584
Turbeville SD, Cowan LD, Gass JD (2003) Acute macular neuroretinopathy: a review of the literature. Surv Ophthalmol 48(1):1–11
Hughes EH, Siow YC, Hunyor AP (2009) Acute macular neuroretinopathy: anatomic localisation of the lesion with high-resolution OCT. Eye (Lond) 23:2132–2134
Monson BK, Greenberg PB, Greenberg E, Fujimoto JG, Srinivasan VJ, Duker JS (2007) High-speed, ultra-high-resolution optical coherence tomography of acute macular neuroretinopathy. Br J Ophthalmol 91:119–120
Neuhann IM, Inhoffen W, Koerner S, Bartz-Schmidt KU, Gelisken F (2010) Visualization and follow-up of acute macular neuroretinopathy with the Spectralis HRA+ OCT device. Graefes Arch Clin Exp Ophthalmol 248:1041–1044
Sarraf D, Rahimy E, Fawzi AA et al (2013) Paracentral acute middle maculopathy: a new variant of acute macular neuroretinopathy associated with retinal capillary ischemia. JAMA Ophthalmol 131:1275–1287
Fawzi AA, Pappuru R, Sarraf D et al (2012) Acute macular neuroretinopathy. Long-term insights revealed by multimodal imaging. Retina 32:1500–1513
Makino S, Tampo H (2014) Acute macular neuroretinopathy in a 15-year-old boy: optical coherence tomography and visual acuity findings. Case Rep Ophthalmol 5(1):11–15
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pirani, V., Cavallero, E., Mariotti, C. et al. Acute macular neuroretinopathy associated with subclinical cytomegalovirus infection. Int Ophthalmol 37, 727–731 (2017). https://doi.org/10.1007/s10792-016-0299-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10792-016-0299-z