Choroiditis following severe acute respiratory syndrome coronavirus 2 infection in unvaccinated identical twins

Unvaccinated identical twins developed bilateral anterior uveitis soon after the onset of coronavirus disease 2019 symptoms. During follow-up, both patients developed choroiditis, and one twine developed posterior scleritis and serous retinal detachment. Prompt treatment with oral prednisone ameliorated the lesions, and no recurrence was observed at the 18-month follow-up. Choroiditis may rarely be associated with severe acute respiratory syndrome coronavirus 2 infection, and it responds well to corticosteroid therapy. Although the exact mechanism is unknown, we hypothesize that the virus may act as an immunological trigger for choroiditis.

Keywords:
Choroiditis; Coronavirus; COVID-19; SARS-CoV-2; Uveitis

Authorship

Luiz Guilherme Marchesi Mello Corresponding author: Luiz Guilherme Marchesi Mello. E-mail: marchesi_lg@hotmail.com

Substantial contribution to conception and design

Acquisition of data

Analysis and interpretation of data

Drafting of the manuscript

Critical revision of the manuscript for important intellectual content

Final approval of the submitted manuscript

Statistical analysis

Obtaining funding

Administrative, technical, or material support supervision

Research group leadership

Division of Ophthalmology and Laboratory of Investigation in Ophthalmology (LIM-33), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BrazilUniversidade de São PauloBrazilSão Paulo, SP, BrazilDivision of Ophthalmology and Laboratory of Investigation in Ophthalmology (LIM-33), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil

Department of Specialized Medicine, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, ES, BrazilUniversidade Federal do Espírito SantoBrazilVitória, ES, BrazilDepartment of Specialized Medicine, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, ES, Brazil

Ophthalmology Unit, Hospital Universitário Cassiano Antonio Moraes, Empresa Brasileira de Serviços Hospitalares, Vitória, ES, BrazilEmpresa Brasileira de Serviços HospitalaresBrazilVitória, ES, BrazilOphthalmology Unit, Hospital Universitário Cassiano Antonio Moraes, Empresa Brasileira de Serviços Hospitalares, Vitória, ES, Brazil

https://orcid.org/0000-0001-8347-2393

Lara Guedes Lubiana

Substantial contribution to conception and design

Acquisition of data

Analysis and interpretation of data

Drafting of the manuscript

Final approval of the submitted manuscript

Statistical analysis

Obtaining funding

https://orcid.org/0000-0001-7804-6488

Carlos Eduardo Hirata

Substantial contribution to conception and design

Analysis and interpretation of data

Drafting of the manuscript

Critical revision of the manuscript for important intellectual content

Final approval of the submitted manuscript

Statistical analysis

Obtaining funding

https://orcid.org/0000-0001-6260-4932

Mário Luiz Ribeiro Monteiro

Substantial contribution to conception and design

Analysis and interpretation of data

Drafting of the manuscript

Critical revision of the manuscript for important intellectual content

Final approval of the submitted manuscript

Statistical analysis

Obtaining funding

https://orcid.org/0000-0002-7281-2791

Joyce Hisae Yamamoto

Substantial contribution to conception and design

Analysis and interpretation of data

Drafting of the manuscript

Critical revision of the manuscript for important intellectual content

Final approval of the submitted manuscript

Statistical analysis

Obtaining funding

https://orcid.org/0000-0001-6869-2988

Corresponding author: Luiz Guilherme Marchesi Mello. E-mail: marchesi_lg@hotmail.com

Disclosure of potential conflicts of interest: None of the authors have any potential conflicts of interest to disclose.

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Figures

Figures (2)

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Figure 1
Multimodal fundus imaging in twin B. Pretreatment (A) infrared fundus imaging of the right eye and optical coherence tomography (OCT) at panel A’s (B) green and (C) blue arrow regions revealed a serous retinal detachment in the peripapillary region and another smaller one in the temporal region above a localized elevated choroidal lesion. (D) Early and (E) late phases of fluorescein angiography confirmed this. Post-treatment OCT images at the same regions as that of (F) panel B and (G) panel C revealed resolution of the abnormalities.

Thumbnail

Figure 2
Multimodal fundus imaging of the right eye in twin A. Pretreatment montage of (A) color fundus images and (B) early and (C) late phases of fluorescein angiography showing the macular area. (D) The superior lesion on fluorescein angiography. Optical coherence tomography (OCT) images at panel A’s (E) green and (F) blue arrow regions revealed a small serous retinal detachment, focal disruption of the outer retinal layers, and retinal pigment epithelium mottling above a localized elevated choroidal lesion. (G) Post-treatment OCT at the same region as that of the green arrow in panel A revealed outer retinal atrophy and improvement in the choroidal thickening.

Figure 1 Multimodal fundus imaging in twin B. Pretreatment (A) infrared fundus imaging of the right eye and optical coherence tomography (OCT) at panel A’s (B) green and (C) blue arrow regions revealed a serous retinal detachment in the peripapillary region and another smaller one in the temporal region above a localized elevated choroidal lesion. (D) Early and (E) late phases of fluorescein angiography confirmed this. Post-treatment OCT images at the same regions as that of (F) panel B and (G) panel C revealed resolution of the abnormalities.

Figure 2 Multimodal fundus imaging of the right eye in twin A. Pretreatment montage of (A) color fundus images and (B) early and (C) late phases of fluorescein angiography showing the macular area. (D) The superior lesion on fluorescein angiography. Optical coherence tomography (OCT) images at panel A’s (E) green and (F) blue arrow regions revealed a small serous retinal detachment, focal disruption of the outer retinal layers, and retinal pigment epithelium mottling above a localized elevated choroidal lesion. (G) Post-treatment OCT at the same region as that of the green arrow in panel A revealed outer retinal atrophy and improvement in the choroidal thickening.

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Choroiditis following severe acute respiratory syndrome coronavirus 2 infection in unvaccinated identical twins

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[1] Corresponding author: Luiz Guilherme Marchesi Mello. E-mail: marchesi_lg@hotmail.com