Anaemic retinopathy in Kikuchi-Fujimoto disease.

A 35-year-old female came to the emergency department with complaints of severe abdominal pain, vomiting, generalized body weakness, fever spikes, and joint pain in hands and feet for the last 1 week. She additionally complained of diminution of vision in both eyes since the past 15 days. A month ago, she was diagnosed with Kikuchi–Fujimoto disease (KFD: histiocytic necrotizing lymphadenitis) on histopathological examination of the excised axillary lymph node. She had severe anemia (Hb: 6.7%), hepatomegaly, and dilated portal and splenic veins on USG-abdomen. Ophthalmic evaluation revealed a BCVA of 6/9, N6 and 6/6, N6 in right and left eye, respectively, and normal anterior segment in both eyes. Fundus examination revealed multiple cotton wool spots over the posterior pole in both eyes, with a blot hemorrhage in the left eye along the inferior arcade. OCT of the right eye revealed paracentral acute middle maculopathy (PAMM) lesions, while the left eye had a thickened outer plexiform layer [Fig. 1].

Figure 1

(a and b) Smart-phone imaging (Samsung Galaxy M21) of the right and left eye respectively showing multiple cotton wool spots over the posterior pole. Blot hemorrhage in the left eye along the inferior arcade. (c) SD-OCT of the right eye showing hyperreflective bands at the level of INL (blue arrows) suggestive of PAMM (paracentral acute middle maculopathy). (d) SD-OCT of the left eye with compact fovea and thickened OPL nasally (red star)

Discussion

Various ophthalmic manifestations such as panuveitis, occlusive vasculitis, oculomotor palsy, and conjunctivitis have been documented in KFD.[123] Recently, sub-ILM and pre-retinal hemorrhage have been reported.[34] Anemia is a common feature of the disease; however, no case of associated retinopathy has been reported so far. We report an important ophthalmic manifestation of anemic retinopathy in Kikuchi–Fujimoto disease, which is probably underdiagnosed given the rarity of the disease.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.