Isolated cotton-wool spot during pregnancy: A case report

Abstract

Introduction: The presence of cotton-wool spots warrants a full systemic workup. We present a case of an isolated cotton-wool spot in a pregnant woman with visual changes after a recent flu-like illness. Case Report: A 25 year-old Middle Eastern female at the 20 th gestational age with a past medical history of Lyme disease, presented with a 24-hour history of a sudden onset of a dark, horizontal line in the center of her right eye vision. She experienced a flu-like illness while on a recent trip to Puerto Rico. Dilated fundus exam revealed an isolated cotton-wool spot along the superior temporal arcade of the right eye, producing focal Retinal Nerve Fiber Layer thickness. Buried optic disc drusen were detected by ocular ultrasound bilaterally. Inflammatory/infectious blood workup, including antibody against Zika virus, was negative except for a mild increase of ANA titer (1:40) in the absence of rheumatologic disease. The patient was managed conservatively and no treatment was initiated. At 4-month follow-up, there was a nearly complete resolution of the cotton-wool spot in the absence of any visual symptoms. The patient had a full-term uncomplicated vaginal delivery. Discussion: The presence of cotton-wool spots, alone or in combination with other clinical findings, warrants further investigation. Although most cotton-wool spots resolve without long-term visual sequelae and could be managed with close observation only, they have been associated with life- or sight-threatening conditions. Therefore, any underlying causes should be identified and treated appropriately. Given the absence of a pre-specified workup for cotton-wool spots, the extent and type of workup should be dictated by the appropriate clinical context.