Rheumatic heart disease presenting with paracentral acute middle maculopathy (PAMM): A case report from rural India

Abstract

A 38-year-old gentleman presented to us with disturbance in his superior field of view for 3 days. His visual acuity in both eyes was 6/6, N6. The macula of the left eye had a hypopigmented band. OCT demonstrated hyperreflectivity of the inner plexiform, inner nuclear, and outer plexiform layers of the retina, and perimetry showed a corresponding visual field defect. The patient revealed a history of heart surgery 26 years ago, and an echocardiogram revealed mitral valve abnormalities. The history and findings led to a diagnosis of paracentral acute middle maculopathy (PAMM) secondary to rheumatic heart disease. The patient was referred to a cardiologist and started on anti-platelet medications. Thus, we report an unusual case of PAMM due to chronic rheumatic heart disease in a young male from remote rural India. In our case, we made sure to start the patient on anti-platelet medications to prevent future adverse events.