Retinal Vasculitis in a Patient With Mixed Connective Tissue Disease Following COVID-19 Infection: Correlation or Coincidence?

Abstract

We report the systemic and ophthalmic findings in a female patient with mixed connective tissue disease (MCTD) who subsequently developed retinal vasculitis following coronavirus disease 2019 (COVID-19) reinfection. The patient was a known case of MCTD maintained in remission on immunosuppressive treatment. She subsequently developed retinal vasculitis with areas of capillary non-perfusion in the right eye. This was a finding not seen previously. She was started on an enhanced immunosuppressive regimen along with scatter laser photocoagulation. COVID-19 has been reported to lead to the development of autoimmune disease, both de novo as well as the worsening of pre-existing disease. The onset of retinal vasculitis may potentially be due to a post-COVID-19 exacerbation of her pre-existing MCTD. Physicians should be aware of this possibility and screen for the same.

Keywords: covid-19; fundoscopy; mixed connective tissue disease; retinal vasculitis; systemic inflammatory and autoimmune disease.

Figure 1. Chest X-ray showing multiple shadows across the upper, mid, and lower zones bilaterally. The arrows point to the lung field shadows on the right side

Figure 2. CT scan of the chest showing multiple ground-glass opacities scattered throughout the lung fields consistent with resolving COVID-19 pneumonia. The arrow points to an area of ground-glass opacity

CT: computed tomography; COVID-19: coronavirus disease 2019

Figure 3. Fundus photograph of the right eye showing areas of narrowing and vasculitis (white arrows)

Figure 4. Fundus photograph of the inferotemporal quadrant of the right eye showing vasculitis (white arrows) and intraretinal hemorrhages (black arrow)

Figure 5. OCTA image showing areas of capillary dropout (ischemia) within the superficial capillary network (white arrows mark the boundaries of the ischemic areas)

OCTA: optical coherence tomography angiography