Author: Lucia Santana-Garcia
Co-authors: MIRIAM GARCIA-FERNANDEZ, ALVARO FERNANDEZ-VEGA, MARIA CARMEN COSTALES ALVAREZ, BEGOÑA BAAMONDE ARBAIZA, LUIS FERNANDEZ VEGA
Abstract
Purpose: To inform the scientific community about a possible association between vaccination against COVID-19 and Acute Retinal Necrosis (ARN) due to Varicella Zoster Virus (VZV).Setting: There are several recent studies on cutaneous VZV reactivation after COVID-19 vaccine administration. Nevertheless, ARN is a devastating and rare uveitic syndrome that usually occurs in immunocompromised patients, being VZV the most frequent cause, with no clear association with vaccination published yet.
Methods: Retrospective observational case report.
Results: A 53-year-old male patient, with previous history of ankylosing spondylitis, came to our hospital due to a sudden loss of visual acuity in his right eye, 48 hours after the administration of first dose of mRNA-1273® vaccine against COVID-19. Best corrected visual acuity (BCVA) was 0.16/1 in right eye and 1/1 in left eye. Moderate inflammatory reaction in the anterior chamber and intense vitritis were observed, with 360º occlusive periarteritis and macular involvement in right eye. Suspecting ARN, an aqueous humor sample was obtained, which confirmed the presence of VZV. The patient was hospitalised for combined treatment with Acyclovir 10mg/kg every 8h and intravenous methylprednisolone, as well as weekly intravitreal injections of Foscarnet. After 14 days, his BCVA was 0.5/1, accompanied by a great decrease in inflammatory activity. Discharge treatment was: Valacyclovir 1g every 8h for 6 weeks, as well as topical and oral corticosteroids in descending regimen. Two months later, his BCVA was 1/1 in right eye and substantial improvement in the funduscopic appearance was observed, without involvement of the opposite eye at any time.
Conclusions: Patients with autoimmune diseases may manifest aberrant immune reactions that could lead to reactivation of latent VZV. This is, however, the first reported case of acute retinal necrosis due to VZV post-vaccination in Europe.
NO financial disclosure or conflicts of interest.
