Bilateral Retinal Ischemia in a Child with Influenza A: A Case Report.

INTRODUCTION

Influenza A can cause extrapulmonary complications, including ocular manifestations. We present a rare case of extensive bilateral retinal ischemia in a pediatric patient following influenza A infection, involving acute macular neuroretinopathy (AMN), paracentral acute middle maculopathy (PAMM), and cotton-wool spots.

CASE PRESENTATION: A 10-year-old boy presented with bilateral blurry vision 4 days after confirmed influenza A infection. Ophthalmologic evaluation revealed best-corrected visual acuity (BCVA) of 20/150 OD and 20/125 OS, with optical coherence tomography (OCT) demonstrating hyperreflective bands in the inner nuclear layer, outer plexiform layer, and outer nuclear layer, consistent with simultaneous AMN and PAMM. Cotton-wool spots were also present. The patient was treated with intravenous methylprednisolone, followed by oral prednisolone. BCVA improved to 20/20 in both eyes at 10 months, with complete resolution of OCT findings.

CONCLUSION

This case highlights the importance of early ophthalmologic assessment in children with visual symptoms following viral infections and suggests a potential role for corticosteroid treatment in severe post-viral retinal ischemia. Further studies are needed to clarify the efficacy of corticosteroids in such cases.