Unilateral Frosted Branch Angiitis in An Immunocompromised Patient With Concurrent Coronavirus Disease 2019 Infection

Background: Frosted branch angiitis is an uncommon ocular sign with multiple causes. With the advent of coronavirus disease 2019 (COVID-19) pandemic, more and more cases of ocular manifestation with COVID-19 has been reported. These poses great challenges to clinicians when handling COVID-19 patients with ocular signs and symptoms. The challenges are even greater when dealing with uncommon disease that co-exists with COVID-19 as both diseases are not well understood. Finding We report the first case of frosted branch angiitis in a patient with coexisting cytomegalovirus and COVID-19 infection. A 33- year-old gentleman with underlying acquired immunodeficiency syndrome who was newly started on highly active antiretroviral therapy, complained of gradual blurring of vision one month after he was diagnosed positive for COVID-19. Upon clinical examination, fundus findings demonstrated extensive perivascular sheathing of both artery and vein, suggestive of frosted branch angiitis of the right eye. Laboratory investigations revealed both nasal swab for COVID-19 polymerase chain reaction and serum cytomegalovirus antibody was positive. The patient was then admitted to COVID-19 ward and treated with intravenous ganciclovir. Conclusion The challenges remain when handling Covid-19 patients with FBA. However, clinicians need to be aware of the possible coexistence of COVID-19 in an immunocompromised patient with frosted branch angiitis.