key: cord-0924166-jt3edwbk authors: Navel, Valentin; Chiambaretta, Frédéric; Dutheil, Frédéric title: Haemorrhagic conjunctivitis with pseudomembranous related to SARS-CoV-2 date: 2020-05-06 journal: Am J Ophthalmol Case Rep DOI: 10.1016/j.ajoc.2020.100735 sha: 7cf951b358bd00fc37cfd17e8d8e76a8f90c01a8 doc_id: 924166 cord_uid: jt3edwbk Abstract Purpose To describe the multiplicity of ocular manifestations of COVID-19 patients, we report a case of pseudomembranous and hemorrhagic conjunctivitis related with SARS-CoV-2 pneumonia in a patient of intensive care unit (ICU). Observations A 63-year-old male was admitted in intensive care unit (ICU), seven days after the beginning of an influenza-like symptoms, to manage an acute respiratory syndrome related with SARS-CoV-2. Chest scan showed interstitial pneumonia with “crazy paving” patterns. At day 19, ocular examination at the patient's bed described petechias and tarsal hemorrhages, mucous filaments and tarsal pseudomembranous. Conjunctival scrapings and swabs did not identify any bacteria or virus. To our knowledge, we described the first case of pseudomembranous conjunctivitis in a COVID-19 patient. Conclusion and importance Considering that SARS-CoV-2 is present in tears and conjunctival secretions, external ocular infections could be factors of infectious spreading. Physicians should be aware of late (>2 weeks) ocular complications in COVID-19 patients to prevent sequelae. In December 2019, a viral pneumonia epidemic named coronavirus disease (COVID-19) was initially described in Wuhan, China and rapidly spread around the world to become the most severe pandemic since Spanish Influenza. 1 Because of phylogenetic analyses, the virus was later named Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2). Despite unprecedented containment (more than half of world population), hundreds of thousands patients were infected among whom some developed severe respiratory symptoms requiring assisted ventilation and intensive care unit resources. The primary mode of transmission seem to be direct or indirect contact of mucous membrane with Pflügge droplets. 2 Considering that the virus is present in tears and conjunctival secretions, external ocular infections could be factors of infectious spreading. 3 There are few reports on the association of SARS-CoV-2 with ocular manifestations. In a Chinese case series, Wu et al. described nearly 30% of ocular symptoms in COVID-19 patients, including conjunctival hyperemia, chemosis, epiphora, or secretions. 4 To describe the multiplicity of ocular manifestations of COVID-19, we report a case of pseudomembranous and hemorrhagic conjunctivitis related with SARS-CoV-2 pneumonia in a patient of intensive care unit (ICU). A 63-year-old male was hospitalized and diagnosed COVID-19 two days (day 2) after the beginning of an influenza-like symptoms including cough, myalgia, nausea and headache. His SARS-CoV-2 is well-known to cause life-threatening respiratory failure, but symptoms in other organs should not be ignored because representing alternative modes of transmission and putative others complications. Here, we describe the first published case of pseudomembranous conjunctivitis in a COVID-19 patient hospitalized in ICU. It seems to be salient to characterize the different ocular manifestations of SARS-CoV-2 to identify typical ocular disease due to coronavirus, and to prevent other source of contagion. In this case, the ocular examination had to be performed at patient's bed because of assisted ventilation and respiratory depression. The first ocular symptoms were developed two weeks after influenzalike symptoms. As recently published, most benign ocular complaints in COVID-19 patients occur around two weeks after the first symptoms, and involve conjunctival hyperemia, chemosis, epiphora, or secretions. 4 Conjunctival swabs were negative in our case, which is consistent with literature reporting only 5% of patients with positive sampling. 4 Consent to publish this case report was not obtained. The report does not contain any personal information that could lead to the identification of the patient. No funding or grant support. All authors attest that they meet the current ICMJE criteria for Authorship. The following authors have no financial disclosures Considering that SARS-CoV-2 is present in tears and conjunctival secretions, external ocular infections could be factors of infectious spreading. However, conjunctival swabs seem to be often negative, complexifying the diagnosis. Physicians should be aware of late Escaping Pandora's Box -Another Novel Coronavirus The Severe Acute Respiratory Syndrome Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS CoV 2 infection Characteristics of Ocular Findings of Patients With Coronavirus Disease Ocular manifestations of feline infectious peritonitis Identification of a new human coronavirus Can the Coronavirus Disease 2019 (COVID-19) Affect the Eyes? A Review of Coronaviruses and Ocular Implications in Humans and Animals Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China None.