{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T07:24:06Z","timestamp":1780471446810,"version":"3.54.1"},"reference-count":12,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,4,30]]},"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:p>We report a case of Susac syndrome after SARS-CoV-2 infection and subsequent vaccination that presented with meningitis and retinal microembolisation in the form of paracentral acute middle maculopathy (PAMM). After presenting with headache, fever and myalgia followed by scotomata, a woman in her 50s was hospitalised for meningitis; she had had mild COVID-19 infection 2\u2009months prior to admission, having received the first vaccine dose 1\u2009month prior to the neurological manifestation. Eye fundus examination and optical coherence tomography were suggestive of PAMM. D-dimer levels and erythrocyte sedimentation rate were elevated. Before infectious investigation results were available, she was started on empirical antibiotic and antiviral treatment. Having ruled out infectious causes, she was started on high-dose prednisolone. After 1\u2009month, there was partial resolution of retinal lesions. This case highlights that exposure to SARS-CoV-2 antigen may be related to this rare syndrome; treatment with steroids may improve central and retinal impairment.<\/jats:p>","DOI":"10.1136\/bcr-2021-247159","type":"journal-article","created":{"date-parts":[[2022,5,23]],"date-time":"2022-05-23T12:55:59Z","timestamp":1653310559000},"page":"e247159","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Paracentral acute middle maculopathy in Susac syndrome after dual exposure to SARS-CoV-2 antigen"],"prefix":"10.1136","volume":"15","author":[{"given":"Fernando Korn","family":"Malerbi","sequence":"first","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, Federal University of Sao Paulo, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8875-0567","authenticated-orcid":false,"given":"Vinicius Andreoli","family":"Schoeps","sequence":"additional","affiliation":[{"name":"Neurology Division, Universidade de S\u00e3o Paulo, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6523-5172","authenticated-orcid":false,"given":"Kimble","family":"T F Matos","sequence":"additional","affiliation":[{"name":"Opthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,5,10]]},"reference":[{"key":"2025082712413353000_15.5.e247159.1","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2021-242987","article-title":"COVID-19-associated central retinal vein occlusion treated with oral aspirin","volume":"14","author":"Venkatesh","year":"2021","journal-title":"BMJ Case Rep"},{"key":"2025082712413353000_15.5.e247159.2","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2021-242043","article-title":"Paracentral acute middle maculopathy following SARS-CoV-2 infection: the D-dimer hypothesis","volume":"14","author":"Padhy","year":"2021","journal-title":"BMJ Case Rep"},{"key":"2025082712413353000_15.5.e247159.3","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1097\/ICB.0000000000000633","article-title":"Paracentral acute middle maculopathy in Susac syndrome","volume":"14","author":"Haider","year":"2020","journal-title":"Retin Cases Brief Rep"},{"key":"2025082712413353000_15.5.e247159.4","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1097\/ICU.0b013e32834bbfeb","article-title":"Review of Susac syndrome","volume":"22","author":"Bitra","year":"2011","journal-title":"Curr Opin Ophthalmol"},{"key":"2025082712413353000_15.5.e247159.5","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1007\/s10633-010-9244-z","article-title":"Branch retinal artery occlusion with visual field and multifocal ERG in Susac syndrome: a case report","volume":"121","author":"van Winden","year":"2010","journal-title":"Doc Ophthalmol"},{"key":"2025082712413353000_15.5.e247159.6","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1007\/s13760-020-01554-5","article-title":"Susac syndrome following COVID-19 infection","volume":"121","author":"Venditti","year":"2021","journal-title":"Acta Neurol Belg"},{"key":"2025082712413353000_15.5.e247159.7","doi-asserted-by":"publisher","DOI":"10.1007\/s12185-020-03029-y"},{"key":"2025082712413353000_15.5.e247159.8","first-page":"7","article-title":"COVID-19: a great mime or a trigger event of autoimmune manifestations?","volume":"17","author":"Fatone","year":"2021","journal-title":"Curr Rheumatol Rev"},{"key":"2025082712413353000_15.5.e247159.9","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1007\/s13365-021-01022-7","article-title":"Susac syndrome complicating a SARS-CoV-2 infection","volume":"27","author":"Raymaekers","year":"2021","journal-title":"J Neurovirol"},{"key":"2025082712413353000_15.5.e247159.10","doi-asserted-by":"crossref","first-page":"363","DOI":"10.3390\/vaccines10030363","article-title":"Susac syndrome following COVID-19 vaccination: a case report","volume":"10","author":"Chen","year":"2022","journal-title":"Vaccines"},{"key":"2025082712413353000_15.5.e247159.11","doi-asserted-by":"crossref","DOI":"10.1001\/jamaophthalmol.2021.3477","article-title":"Association of ocular adverse events with inactivated COVID-19 vaccination in patients in abu dhabi","volume":"139","author":"Pichi","year":"2021","journal-title":"JAMA Ophthalmol"},{"key":"2025082712413353000_15.5.e247159.12","doi-asserted-by":"crossref","unstructured":"Jampol LM , Tauscher R , Schwarz HP . COVID-19, COVID-19 vaccinations, and subsequent abnormalities in the retina: causation or coincidence? 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