Case Report: Acute Macular Neuroretinopathy Following Hepatitis A and Typhoid Vaccinations

Introduction Acute macular neuroretinopathy diagnosis has increased in prevalence amid improved disease awareness and the recent SARS-CoV-2 outbreak and COVID-19 vaccination efforts. Febrile illness and oral contraceptive medications are risk factors traditionally associated with acute macular neuroretinopathy. Improved retinal imaging techniques enable greater diagnostic accuracy, but the complete disease pathology remains uncertain. Outer retinal and choroidal circulatory changes suggest small vessel ischemia leading to irreversible photoreceptor damage. Case Report A 36-year-old woman presented with a persistent, paracentral scotoma in her right eye, the onset of which came 4 months prior to her initial presentation. Ophthalmic examination, perimetry, and multimodal retinal imaging confirmed outer retinal disease, which was consistent with acute macular neuroretinopathy. A thorough case history revealed recent hepatitis A and live oral typhoid vaccinations as 2 novel correlatives. Conclusion This case report highlights the clinical presentation and chronicity of acute macular neuroretinopathy several months after initial symptom onset. Additionally, this is the first case report to identify 2 new risk factors, hepatitis A and typhoid vaccinations, associated with the diagnosis of acute macular neuroretinopathy.