Combined retinal and choroidal microvasculopathy in a non-diabetic kidney transplant recipient following SARS-CoV-2 infection

Abstract Purpose: To present a case of a kidney transplant recipient with multiple, concurrent signs of retinal and choroidal microvascular dysfunction following mild coronavirus disease 2019 (COVID-19). Observations: An immunosuppressed, 51-year-old male with a history of kidney transplantation at an earlier stage, presented with bilateral conjunctivitis and blurry vision that coincided with a SARS-CoV-2-positive upper respiratory tract infection. On examination, we observed bilateral vitritis as well as choroidal congestion with signs of outer retinal and inner choroidal microvascular dysfunction. Moreover, cotton wool spots, consistent with inner retinal ischemia were noted while the rest of the clinical findings subsided. Conclusions and importance: COVID-19, a multi-systemic disease that primarily affects the respiratory system, has been associated with a number of seemingly diverse ocular phenotypes, where both inflammation and ischemia seem to play role. Moreover, the presence of underlying systemic comorbidities may have an impact on both infection outcomes and the ocular complications of the disease. Kidney transplant recipients that develop SARS-CoV-2 infection may be at higher risk for both choroidal and retinal microvasculopathy with prominent choroidal congestion, pigment epitheliopathy with or without subretinal fluid and hyper-reflective changes in optical coherence tomography suggesting ischemia in different retinal layers.