Retinopathy in a Patient With Influenza Associated Pancytopenia

Retinal abnormalities can be manifestations of hematologic disturbances such as anemia and thrombocytopenia. Influenza associated pancytopenia has rarely been reported in the literature apart from cases involving bacterial superinfection or immunocompromised patients. We present a case of a 14-year-old female with influenza A who was found to be profoundly pancytopenic and developed intraretinal hemorrhages likely secondary to anemic retinopathy. Her hematologic workup was negative for underlying anomalies and she was diagnosed with severe aplastic anemia. The patient's retinal hemorrhages completely resolved over the course of seven months despite declining immunosuppressive therapy and continued persistent pancytopenia. Visual acuity improved from 20/200 to 20/25 in both eyes. Resolution of anemic retinopathy has traditionally followed a return to normal hematologic values. This patient's case shows that retinal hemorrhage may reabsorb despite continuing underlying pancytopenia, emphasizing the need for further investigation into the relationship between systemic hematologic disturbances and retinal complications.