Acute idiopathic blind spot enlargement syndrome following measles, mumps and rubella vaccination
2018; Elsevier BV; Volume: 54; Issue: 4 Linguagem: Inglês
10.1016/j.jcjo.2018.09.005
ISSN1715-3360
AutoresMelody Wong, Maria Gabriela Campos-Baniak, Kevin Colleaux,
Tópico(s)Glaucoma and retinal disorders
ResumoAcute idiopathic blind spot enlargement syndrome (AIBSES) is a primary inflammatory choriocapillaropathy (PICCP) found mainly in young to middle-age female subjects.1Liu X. Chen B. Zhang M. Huang H. Clinical Features and Differential Diagnosis of Acute Idiopathic Blind Spot Enlargement Syndrome.Eye Sci. 2014; 29: 143-150PubMed Google Scholar Characteristic symptoms include an acute monocular shadow or scotoma, photopsias and reduced light perception, and visual acuity is usually normal to slightly diminished. The etiology of AIBSES remains unknown, but it has been suggested that AIBSES may be related to or part of a spectrum including other syndromes and PICCPs. Additionally, there have been numerous case reports of PICCPs following vaccination, but to our knowledge there have been no cases of AIBSES following vaccination. We present a case of AIBSES following measles, mumps and rubella (MMR) vaccine to explore the disease entity, review similar syndromes, and highlight vaccination as an important consideration in the differential diagnosis of a chorioretinal inflammatory syndrome. A 29-year-old female presented to our Urgent Eye Care centre complaining of new floaters and a temporal scotoma for the past week. Past medical history, past ocular history and family history were unremarkable, except that the patient received MMR vaccination 20 days prior to the onset of her symptoms. On examination, visual acuity was 20/20 bilaterally at presentation. Pupillary responses, slit lamp examination and dilated fundus examination were unremarkable. Further testing with Humphrey 24-2 visual field showed an enlargement of the blind spot (Figure 1). OCT of the nerve and macula showed disruption of the ellipsoid zone in the paramacular and peripapillary locations (Figure 2). Initial ultra-wide field imaging (OPTOS) revealed peripapillary changes (Figure 3). A diagnosis of AIBSES was made. Follow-up 6 weeks later revealed improvement in both visual field and retinal imaging. Repeat OCT showed recovery of the ellipsoid zone. Autofluorescence revealed hyperfluorescence in the peripapillary retina. Fluorescein angiography performed 6 weeks from initial presentation showed mild late staining of the peripapillary retina (Figure 4). An ERG was not performed on this patient as it was not possible to obtain it at our centre at the time of her presentation. Multifocal ERG can show subtle abnormalities in patients with active AIBSES. We elected not to proceed with this test due to the significant travel burden it would have caused our patient, and it was felt that there was sufficient diagnostic certainty without obtaining multifocal ERG.Fig. 2Optical Coherence Tomography of the right eye. The images above show patches of IS/OS disruption in the paramacular and peripapillary locations. The images below taken 6 weeks later show recovery of the ellipsoid zone.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig. 3Initial ultra-wide field imaging (OPTOS) colour and red-free (above) and follow-up 6 weeks later (below).View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig. 4Fluorescein angiography at six weeks follow-up showing mild peripapillary hyperfluorescence.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Classically, AIBSES presents with monocular shadow or scotoma, photopsia and reduced light perception. Physical examination usually reveals a normal fundus and optic disc, but some patients may have mild optic disc swelling or intraocular inflammation.1Liu X. Chen B. Zhang M. Huang H. Clinical Features and Differential Diagnosis of Acute Idiopathic Blind Spot Enlargement Syndrome.Eye Sci. 2014; 29: 143-150PubMed Google Scholar–3Volpe N. Rizzo J. Lessell S. Acute Idiopathic Blind Spot Enlargement Syndrome - A Review of 27 New Cases.Arch Ophthalmol [Internet]. 2001; 119 (Available from): 59-63http://archopht.jamanetwork.com/article.aspx?articleid=637061PubMed Google Scholar Diagnosis is easily missed as the condition lacks explicit changes in the early stages of the disease. Most patients achieve symptomatic improvement after 4 weeks; however, the enlarged blind spot typically does not return to normal. Additional investigations may reveal numerous abnormalities, including blind spot enlargement on visual field testing, peripapillary leakage with fundus angiography (FA), hypofluorescence with indocyanine green angiography (ICGA), losses in the outer retinal layers with optical coherent tomography (OCT) and changes in electroretinography (ERG), with multifocal ERG being more frequently abnormal than full-field ERG.1Liu X. Chen B. Zhang M. Huang H. Clinical Features and Differential Diagnosis of Acute Idiopathic Blind Spot Enlargement Syndrome.Eye Sci. 2014; 29: 143-150PubMed Google Scholar–3Volpe N. Rizzo J. Lessell S. Acute Idiopathic Blind Spot Enlargement Syndrome - A Review of 27 New Cases.Arch Ophthalmol [Internet]. 2001; 119 (Available from): 59-63http://archopht.jamanetwork.com/article.aspx?articleid=637061PubMed Google Scholar Although the etiology of the condition is not known, female gender, high myopia and Caucasian race are known risk factors for AIBSES occurrence.1Liu X. Chen B. Zhang M. Huang H. Clinical Features and Differential Diagnosis of Acute Idiopathic Blind Spot Enlargement Syndrome.Eye Sci. 2014; 29: 143-150PubMed Google Scholar, 2Herbort C.P. Papadia M. Neri P. Myopia and inflammation.J Ophthalmic Vis Res. 2011; 6: 270-283PubMed Google Scholar Liu et al. proposed this four-phase pathogenesis for AIBSES1:1.Acute inflammatory phase, where mild fundus changes can be caused by minor acute inflammation for approximately 2 weeks2.Involuting inflammatory phase, where the acute choriocapillary inflammation is slowly reduced3.Chronic phase, where lesions can grow4.Recovery phase, occurring at approximately 3 – 4 months, where OCT changes slowly resolve and visual function of patients can improve Other PICCPs may be related to AIBSES. MEWDS is classified as a PICCP and a white dot syndrome.2Herbort C.P. Papadia M. Neri P. Myopia and inflammation.J Ophthalmic Vis Res. 2011; 6: 270-283PubMed Google Scholar The etiology of MEWDS is unknown, but some authors hypothesize an immune basis due to multiple episodes following vaccination.4Baglivo E. Safran A.B. Borruat F.-X. Multiple Evanescent White Dot Syndrome After Hepatitis B Vaccine.Am J Ophthalmol. 1996; 122Abstract Full Text PDF PubMed Scopus (62) Google Scholar, 5Fine L. Fine A. Cunningham E. Multiple Evanescent White Dot Syndrome Following Hepatitis A Vaccination.Arch Ophthalmol [Internet]. 2001; 119 (Available from): 1856-1858http://www.ncbi.nlm.nih.gov/pubmed/12617716Crossref PubMed Google Scholar, 6Stangos A. Zaninetti M. Petropoulos I. Baglivo E. Pournaras C. Multiple evanescent white dot syndrome following simultaneous hepatitis-A and yellow fever vaccination.Ocul Immunol Inflamm [Internet]. 2006; 14 (Available from): 301-304http://www.ncbi.nlm.nih.gov/pubmed/17056464Crossref PubMed Scopus (52) Google Scholar, 7Cohen S.M. Multiple Evanescent White Dot Syndrome After Vaccination for Human Papilloma Virus and Meningococcus.J Pediatr Ophthalmol Strabismus. 2009; xxGoogle Scholar, 8Goyal S. Nazarian S.M. Thayi D.R. Hammond F. Petrovic V. Multiple evanescent white dot syndrome following recent influenza vaccination.Canadian Journal of Ophthalmology / Journal Canadien d'Ophtalmologie. 2013; 48: e115-e116Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar MEWDS shares very similar symptomatology and patient population to AIBSES, as both syndromes present in young females with symptoms of photopsia and blind spot enlargement.4Baglivo E. Safran A.B. Borruat F.-X. Multiple Evanescent White Dot Syndrome After Hepatitis B Vaccine.Am J Ophthalmol. 1996; 122Abstract Full Text PDF PubMed Scopus (62) Google Scholar, 5Fine L. Fine A. Cunningham E. Multiple Evanescent White Dot Syndrome Following Hepatitis A Vaccination.Arch Ophthalmol [Internet]. 2001; 119 (Available from): 1856-1858http://www.ncbi.nlm.nih.gov/pubmed/12617716Crossref PubMed Google Scholar, 6Stangos A. Zaninetti M. Petropoulos I. Baglivo E. Pournaras C. Multiple evanescent white dot syndrome following simultaneous hepatitis-A and yellow fever vaccination.Ocul Immunol Inflamm [Internet]. 2006; 14 (Available from): 301-304http://www.ncbi.nlm.nih.gov/pubmed/17056464Crossref PubMed Scopus (52) Google Scholar, 7Cohen S.M. Multiple Evanescent White Dot Syndrome After Vaccination for Human Papilloma Virus and Meningococcus.J Pediatr Ophthalmol Strabismus. 2009; xxGoogle Scholar, 8Goyal S. Nazarian S.M. Thayi D.R. Hammond F. Petrovic V. Multiple evanescent white dot syndrome following recent influenza vaccination.Canadian Journal of Ophthalmology / Journal Canadien d'Ophtalmologie. 2013; 48: e115-e116Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar MEWDS may present with a viral flu-like prodrome prior to developing ocular symptoms.2Herbort C.P. Papadia M. Neri P. Myopia and inflammation.J Ophthalmic Vis Res. 2011; 6: 270-283PubMed Google Scholar, 4Baglivo E. Safran A.B. Borruat F.-X. Multiple Evanescent White Dot Syndrome After Hepatitis B Vaccine.Am J Ophthalmol. 1996; 122Abstract Full Text PDF PubMed Scopus (62) Google Scholar,7Cohen S.M. Multiple Evanescent White Dot Syndrome After Vaccination for Human Papilloma Virus and Meningococcus.J Pediatr Ophthalmol Strabismus. 2009; xxGoogle Scholar Characteristic findings include yellow to white fundus lesions in the fundus, scant papillary edema, little to moderate decline in visual acuity and visual field defects.2Herbort C.P. Papadia M. Neri P. Myopia and inflammation.J Ophthalmic Vis Res. 2011; 6: 270-283PubMed Google Scholar, 4Baglivo E. Safran A.B. Borruat F.-X. Multiple Evanescent White Dot Syndrome After Hepatitis B Vaccine.Am J Ophthalmol. 1996; 122Abstract Full Text PDF PubMed Scopus (62) Google Scholar,5Fine L. Fine A. Cunningham E. Multiple Evanescent White Dot Syndrome Following Hepatitis A Vaccination.Arch Ophthalmol [Internet]. 2001; 119 (Available from): 1856-1858http://www.ncbi.nlm.nih.gov/pubmed/12617716Crossref PubMed Google Scholar, 7Cohen S.M. Multiple Evanescent White Dot Syndrome After Vaccination for Human Papilloma Virus and Meningococcus.J Pediatr Ophthalmol Strabismus. 2009; xxGoogle Scholar Since the white spots in MEWDS disappear within a few weeks, there is speculation that AIBSES and MEWDS are the same entity, with AIBSES manifesting as a late presentation.2Herbort C.P. Papadia M. Neri P. Myopia and inflammation.J Ophthalmic Vis Res. 2011; 6: 270-283PubMed Google Scholar FA may reveal hyperfluorescence and late leakage.2Herbort C.P. Papadia M. Neri P. Myopia and inflammation.J Ophthalmic Vis Res. 2011; 6: 270-283PubMed Google Scholar,4Baglivo E. Safran A.B. Borruat F.-X. Multiple Evanescent White Dot Syndrome After Hepatitis B Vaccine.Am J Ophthalmol. 1996; 122Abstract Full Text PDF PubMed Scopus (62) Google Scholar, 5Fine L. Fine A. Cunningham E. Multiple Evanescent White Dot Syndrome Following Hepatitis A Vaccination.Arch Ophthalmol [Internet]. 2001; 119 (Available from): 1856-1858http://www.ncbi.nlm.nih.gov/pubmed/12617716Crossref PubMed Google Scholar, 6Stangos A. Zaninetti M. Petropoulos I. Baglivo E. Pournaras C. Multiple evanescent white dot syndrome following simultaneous hepatitis-A and yellow fever vaccination.Ocul Immunol Inflamm [Internet]. 2006; 14 (Available from): 301-304http://www.ncbi.nlm.nih.gov/pubmed/17056464Crossref PubMed Scopus (52) Google Scholar, 7Cohen S.M. Multiple Evanescent White Dot Syndrome After Vaccination for Human Papilloma Virus and Meningococcus.J Pediatr Ophthalmol Strabismus. 2009; xxGoogle Scholar ICGA reveals hypofluorescent dots and peripapillary hypofluorescence.2Herbort C.P. Papadia M. Neri P. Myopia and inflammation.J Ophthalmic Vis Res. 2011; 6: 270-283PubMed Google Scholar, 6Stangos A. Zaninetti M. Petropoulos I. Baglivo E. Pournaras C. Multiple evanescent white dot syndrome following simultaneous hepatitis-A and yellow fever vaccination.Ocul Immunol Inflamm [Internet]. 2006; 14 (Available from): 301-304http://www.ncbi.nlm.nih.gov/pubmed/17056464Crossref PubMed Scopus (52) Google Scholar and similar findings have been reported in AIBSES as well.1Liu X. Chen B. Zhang M. Huang H. Clinical Features and Differential Diagnosis of Acute Idiopathic Blind Spot Enlargement Syndrome.Eye Sci. 2014; 29: 143-150PubMed Google Scholar, 2Herbort C.P. Papadia M. Neri P. Myopia and inflammation.J Ophthalmic Vis Res. 2011; 6: 270-283PubMed Google Scholar Prognosis is good in both entities, as MEWDS typically spontaneously resolves within 1‐3 months of onset.2Herbort C.P. Papadia M. Neri P. Myopia and inflammation.J Ophthalmic Vis Res. 2011; 6: 270-283PubMed Google Scholar,4Baglivo E. Safran A.B. Borruat F.-X. Multiple Evanescent White Dot Syndrome After Hepatitis B Vaccine.Am J Ophthalmol. 1996; 122Abstract Full Text PDF PubMed Scopus (62) Google Scholar, 5Fine L. Fine A. Cunningham E. Multiple Evanescent White Dot Syndrome Following Hepatitis A Vaccination.Arch Ophthalmol [Internet]. 2001; 119 (Available from): 1856-1858http://www.ncbi.nlm.nih.gov/pubmed/12617716Crossref PubMed Google Scholar, 6Stangos A. Zaninetti M. Petropoulos I. Baglivo E. Pournaras C. Multiple evanescent white dot syndrome following simultaneous hepatitis-A and yellow fever vaccination.Ocul Immunol Inflamm [Internet]. 2006; 14 (Available from): 301-304http://www.ncbi.nlm.nih.gov/pubmed/17056464Crossref PubMed Scopus (52) Google Scholar, 7Cohen S.M. Multiple Evanescent White Dot Syndrome After Vaccination for Human Papilloma Virus and Meningococcus.J Pediatr Ophthalmol Strabismus. 2009; xxGoogle Scholar, 8Goyal S. Nazarian S.M. Thayi D.R. Hammond F. Petrovic V. Multiple evanescent white dot syndrome following recent influenza vaccination.Canadian Journal of Ophthalmology / Journal Canadien d'Ophtalmologie. 2013; 48: e115-e116Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is also classified as a white dot syndrome and a PICCP.9Daniel B. Andrei B. Clinic E. Street P.R. Acute Posterior Multifocal Placoid Pigment Epitheliopathy Following Influenza Vaccination.Rom J Ophthalmol. 2015; 59: 52-58PubMed Google Scholar, 10Gonome T. Suzuki Y. Metoki T. Takahashi S. Nakazawa M. Acute posterior multifocal placoid pigment epitheliopathy and granulomatous uveitis following influenza vaccination.Am J Ophthalmol Case Reports [Internet]. 2016; 4 (Available from): 60-63http://dx.doi.org/10.1016/j.ajoc.2016.08.008Crossref PubMed Scopus (14) Google Scholar Etiology is thought to be an abnormal immune response to a provoking agent.9Daniel B. Andrei B. Clinic E. Street P.R. Acute Posterior Multifocal Placoid Pigment Epitheliopathy Following Influenza Vaccination.Rom J Ophthalmol. 2015; 59: 52-58PubMed Google Scholar,11Fine H.F. Kim E. Flynn T.E. Gomes N.L. Chang S. Acute posterior multifocal placoid pigment epitheliopathy following varicella vaccination.Br J Ophthalmol [Internet]. 2010; 94 (363. Available from): 282-283http://www.ncbi.nlm.nih.gov/pubmed/18728052Crossref PubMed Scopus (32) Google Scholar, 12Mendrinos E. Baglivo E. Acute posterior multifocal placoid pigment epitheliopathy following influenza vaccination.Eye [Internet]. 2010; 24 (Available from:): 180-181http://www.ncbi.nlm.nih.gov/pubmed/18728052Crossref PubMed Scopus (26) Google Scholar, 13Yang D.S. Hilford D.J. Conrad D. Acute posterior multifocal placoid pigment epitheliopathy after meningococcal C conjugate vaccine.Clin Exp Ophthalmol. 2005; 33: 218-225Crossref PubMed Scopus (20) Google Scholar It presents bilaterally in young adults of any gender with asymmetric visual loss associated with photopsia or scotoma.9Daniel B. Andrei B. Clinic E. Street P.R. Acute Posterior Multifocal Placoid Pigment Epitheliopathy Following Influenza Vaccination.Rom J Ophthalmol. 2015; 59: 52-58PubMed Google Scholar, 11Fine H.F. Kim E. Flynn T.E. Gomes N.L. Chang S. Acute posterior multifocal placoid pigment epitheliopathy following varicella vaccination.Br J Ophthalmol [Internet]. 2010; 94 (363. Available from): 282-283http://www.ncbi.nlm.nih.gov/pubmed/18728052Crossref PubMed Scopus (32) Google Scholar,13Yang D.S. Hilford D.J. Conrad D. Acute posterior multifocal placoid pigment epitheliopathy after meningococcal C conjugate vaccine.Clin Exp Ophthalmol. 2005; 33: 218-225Crossref PubMed Scopus (20) Google Scholar It may present with a flu-like prodrome.10Gonome T. Suzuki Y. Metoki T. Takahashi S. Nakazawa M. Acute posterior multifocal placoid pigment epitheliopathy and granulomatous uveitis following influenza vaccination.Am J Ophthalmol Case Reports [Internet]. 2016; 4 (Available from): 60-63http://dx.doi.org/10.1016/j.ajoc.2016.08.008Crossref PubMed Scopus (14) Google Scholar, 12Mendrinos E. Baglivo E. Acute posterior multifocal placoid pigment epitheliopathy following influenza vaccination.Eye [Internet]. 2010; 24 (Available from:): 180-181http://www.ncbi.nlm.nih.gov/pubmed/18728052Crossref PubMed Scopus (26) Google Scholar Fundus examination reveals placoid lesions, usually less than one disc diameter and located mainly in the posterior pole.9Daniel B. Andrei B. Clinic E. Street P.R. Acute Posterior Multifocal Placoid Pigment Epitheliopathy Following Influenza Vaccination.Rom J Ophthalmol. 2015; 59: 52-58PubMed Google Scholar,11Fine H.F. Kim E. Flynn T.E. Gomes N.L. Chang S. Acute posterior multifocal placoid pigment epitheliopathy following varicella vaccination.Br J Ophthalmol [Internet]. 2010; 94 (363. Available from): 282-283http://www.ncbi.nlm.nih.gov/pubmed/18728052Crossref PubMed Scopus (32) Google Scholar, 12Mendrinos E. Baglivo E. Acute posterior multifocal placoid pigment epitheliopathy following influenza vaccination.Eye [Internet]. 2010; 24 (Available from:): 180-181http://www.ncbi.nlm.nih.gov/pubmed/18728052Crossref PubMed Scopus (26) Google Scholar, 13Yang D.S. Hilford D.J. Conrad D. Acute posterior multifocal placoid pigment epitheliopathy after meningococcal C conjugate vaccine.Clin Exp Ophthalmol. 2005; 33: 218-225Crossref PubMed Scopus (20) Google Scholar FA may reveal blocked choroidal fluorescence and late hyperfluorescence without leakage.9Daniel B. Andrei B. Clinic E. Street P.R. Acute Posterior Multifocal Placoid Pigment Epitheliopathy Following Influenza Vaccination.Rom J Ophthalmol. 2015; 59: 52-58PubMed Google Scholar, 11Fine H.F. Kim E. Flynn T.E. Gomes N.L. Chang S. Acute posterior multifocal placoid pigment epitheliopathy following varicella vaccination.Br J Ophthalmol [Internet]. 2010; 94 (363. Available from): 282-283http://www.ncbi.nlm.nih.gov/pubmed/18728052Crossref PubMed Scopus (32) Google Scholar ICGA may reveal hypofluorescence.12Mendrinos E. Baglivo E. Acute posterior multifocal placoid pigment epitheliopathy following influenza vaccination.Eye [Internet]. 2010; 24 (Available from:): 180-181http://www.ncbi.nlm.nih.gov/pubmed/18728052Crossref PubMed Scopus (26) Google Scholar Prognosis is good as most patients recover visual acuity to 20/40 or better.9Daniel B. Andrei B. Clinic E. Street P.R. Acute Posterior Multifocal Placoid Pigment Epitheliopathy Following Influenza Vaccination.Rom J Ophthalmol. 2015; 59: 52-58PubMed Google Scholar,11Fine H.F. Kim E. Flynn T.E. Gomes N.L. Chang S. Acute posterior multifocal placoid pigment epitheliopathy following varicella vaccination.Br J Ophthalmol [Internet]. 2010; 94 (363. Available from): 282-283http://www.ncbi.nlm.nih.gov/pubmed/18728052Crossref PubMed Scopus (32) Google Scholar, 12Mendrinos E. Baglivo E. Acute posterior multifocal placoid pigment epitheliopathy following influenza vaccination.Eye [Internet]. 2010; 24 (Available from:): 180-181http://www.ncbi.nlm.nih.gov/pubmed/18728052Crossref PubMed Scopus (26) Google Scholar, 13Yang D.S. Hilford D.J. Conrad D. Acute posterior multifocal placoid pigment epitheliopathy after meningococcal C conjugate vaccine.Clin Exp Ophthalmol. 2005; 33: 218-225Crossref PubMed Scopus (20) Google Scholar Multifocal choriditis (MFC) is a bilateral chorioretinal inflammatory disease.2Herbort C.P. Papadia M. Neri P. Myopia and inflammation.J Ophthalmic Vis Res. 2011; 6: 270-283PubMed Google Scholar, 14Escott S. Tarabishy A.B. Davidorf F.H. Multifocal choroiditis following simultaneous hepatitis a, typhoid, and yellow fever vaccination.Clin Ophthalmol. 2013; 7: 363-365Crossref PubMed Google Scholar Similar to other inflammatory choriocapillaropathies, symptoms of MFC include photopsia, scotoma, visual field defects and decreased visual acuity.2Herbort C.P. Papadia M. Neri P. Myopia and inflammation.J Ophthalmic Vis Res. 2011; 6: 270-283PubMed Google Scholar, 14Escott S. Tarabishy A.B. Davidorf F.H. Multifocal choroiditis following simultaneous hepatitis a, typhoid, and yellow fever vaccination.Clin Ophthalmol. 2013; 7: 363-365Crossref PubMed Google Scholar Fundus examination reveals multiple small yellow lesions that evolve into permanent scars.2Herbort C.P. Papadia M. Neri P. Myopia and inflammation.J Ophthalmic Vis Res. 2011; 6: 270-283PubMed Google Scholar, 14Escott S. Tarabishy A.B. Davidorf F.H. Multifocal choroiditis following simultaneous hepatitis a, typhoid, and yellow fever vaccination.Clin Ophthalmol. 2013; 7: 363-365Crossref PubMed Google Scholar ICGA reveals hypofluorescence2Herbort C.P. Papadia M. Neri P. Myopia and inflammation.J Ophthalmic Vis Res. 2011; 6: 270-283PubMed Google Scholar, and FA reveals late hyperfluorescent lesions.2Herbort C.P. Papadia M. Neri P. Myopia and inflammation.J Ophthalmic Vis Res. 2011; 6: 270-283PubMed Google Scholar, 14Escott S. Tarabishy A.B. Davidorf F.H. Multifocal choroiditis following simultaneous hepatitis a, typhoid, and yellow fever vaccination.Clin Ophthalmol. 2013; 7: 363-365Crossref PubMed Google Scholar Management involves corticosteroids and occasionally immunosuppressants for active disease, and prognosis is variable but usually favorable.2Herbort C.P. Papadia M. Neri P. Myopia and inflammation.J Ophthalmic Vis Res. 2011; 6: 270-283PubMed Google Scholar, 14Escott S. Tarabishy A.B. Davidorf F.H. Multifocal choroiditis following simultaneous hepatitis a, typhoid, and yellow fever vaccination.Clin Ophthalmol. 2013; 7: 363-365Crossref PubMed Google Scholar Vaccination has been cited as a potential precipitating cause for other PICCPs. Known possible adverse events of the MMR vaccination include fever, rash, lymphadenopathy, febrile seizures, parotitis, anaphylaxis, thrombocytopenic purpura, transient arthralgias, Guillain-Barré syndrome, encephalitis and myocarditis.15Sukumaran L, Mcneil MM, Moro PL, Lewis PW, Winiecki SK, Shimabukuro TT. Adverse Events Following Measles, Mumps, and Rubella Vaccine in Adults Reported to the Vaccine Adverse Event Reporting System (VAERS), 2003 – 2013. 2015;60:58–65.Google Scholar Vaccinations may predispose to immune-mediated inflammatory conditions through molecular mimicry, a theoretical concept in which similarities in the sequences of newly introduced antigens to host peptides may cause an autoimmune response.12Mendrinos E. Baglivo E. Acute posterior multifocal placoid pigment epitheliopathy following influenza vaccination.Eye [Internet]. 2010; 24 (Available from:): 180-181http://www.ncbi.nlm.nih.gov/pubmed/18728052Crossref PubMed Scopus (26) Google Scholar, 14Escott S. Tarabishy A.B. Davidorf F.H. Multifocal choroiditis following simultaneous hepatitis a, typhoid, and yellow fever vaccination.Clin Ophthalmol. 2013; 7: 363-365Crossref PubMed Google Scholar We conducted a literature review searching for all cases of AIBSES or related entities following vaccination or injection of any kind. To our knowledge, there have been no reported cases of AIBSES following vaccination or injection of any kind. However, there have been some cases of related syndromes arising following vaccination. Table 1 below summarizes the cases.Table 1Cases of AIBSES-related entities following vaccinationAuthors (Year Published)Title of Publication (Journal)DemographicsDiagnosis GivenVaccination Given and Time to PresentationBaglivo et al. (1996)4Baglivo E. Safran A.B. Borruat F.-X. Multiple Evanescent White Dot Syndrome After Hepatitis B Vaccine.Am J Ophthalmol. 1996; 122Abstract Full Text PDF PubMed Scopus (62) Google ScholarMultiple Evanescent White Dot Syndrome after Hepatitis B Vaccine (Am J Ophthal)23yo femaleMEWDSHepatitis B (24 hours)Fine et al. (2001)5Fine L. Fine A. Cunningham E. Multiple Evanescent White Dot Syndrome Following Hepatitis A Vaccination.Arch Ophthalmol [Internet]. 2001; 119 (Available from): 1856-1858http://www.ncbi.nlm.nih.gov/pubmed/12617716Crossref PubMed Google ScholarMultiple Evanescent White Dot Syndrome Following Hepatitis A Vaccination (Arch Ophthalmol)30yo maleMEWDSHepatitis A (13 days)Yang et al. (2005)13Yang D.S. Hilford D.J. Conrad D. Acute posterior multifocal placoid pigment epitheliopathy after meningococcal C conjugate vaccine.Clin Exp Ophthalmol. 2005; 33: 218-225Crossref PubMed Scopus (20) Google ScholarAcute posterior multifocal placoid pigment epitheliopathy after meningococcal C conjugate vaccine (Clin Exp Ophthalmol)14yo maleAPMPPEMeningococcal C (6 days)Stangos et al. (2006)6Stangos A. Zaninetti M. Petropoulos I. Baglivo E. Pournaras C. Multiple evanescent white dot syndrome following simultaneous hepatitis-A and yellow fever vaccination.Ocul Immunol Inflamm [Internet]. 2006; 14 (Available from): 301-304http://www.ncbi.nlm.nih.gov/pubmed/17056464Crossref PubMed Scopus (52) Google ScholarMultiple Evanescent White Dot Syndrome Following Simultaneous Hepatitis-A and Yellow Fever Vaccination (Ocul Immunol Inflamm)50yo femaleMEWDSHepatitis A and Yellow Fever (10 days)Cohen7Cohen S.M. Multiple Evanescent White Dot Syndrome After Vaccination for Human Papilloma Virus and Meningococcus.J Pediatr Ophthalmol Strabismus. 2009; xxGoogle Scholar (2008)Multiple Evanescent White Dot Syndrome After Vaccination for Human Papilloma Virus and Meningococcus (J Pediatr Ophthalmol Strabismus)17yo femaleMEWDSHuman Papilloma Virus and Meningococcus (1 month)Fine et al. (2010)11Fine H.F. Kim E. Flynn T.E. Gomes N.L. Chang S. Acute posterior multifocal placoid pigment epitheliopathy following varicella vaccination.Br J Ophthalmol [Internet]. 2010; 94 (363. Available from): 282-283http://www.ncbi.nlm.nih.gov/pubmed/18728052Crossref PubMed Scopus (32) Google ScholarAcute posterior multifocal placoid pigment epitheliopathy following varicella vaccination11yo femaleAPMPPEVaricella (10 days)Mendrinos and Baglivo (2010)12Mendrinos E. Baglivo E. Acute posterior multifocal placoid pigment epitheliopathy following influenza vaccination.Eye [Internet]. 2010; 24 (Available from:): 180-181http://www.ncbi.nlm.nih.gov/pubmed/18728052Crossref PubMed Scopus (26) Google ScholarAcute posterior multifocal placoid pigment epitheliopathy following influenza vaccination27yo maleAPMPPEInfluenza (14 days)Escott et al. (2013)14Escott S. Tarabishy A.B. Davidorf F.H. Multifocal choroiditis following simultaneous hepatitis a, typhoid, and yellow fever vaccination.Clin Ophthalmol. 2013; 7: 363-365Crossref PubMed Google ScholarMultifocal choroiditis following simultaneous hepatitis A, typhoid and yellow fever vaccination33yo maleMFCHepatitis A, typhoid, yellow fever (3 weeks)Goyal et al. (2013)8Goyal S. Nazarian S.M. Thayi D.R. Hammond F. Petrovic V. Multiple evanescent white dot syndrome following recent influenza vaccination.Canadian Journal of Ophthalmology / Journal Canadien d'Ophtalmologie. 2013; 48: e115-e116Abstract Full Text Full Text PDF PubMed Scopus (16) Google ScholarMultiple evanescent white dot syndrome following recent influenza vaccination (Can J Ophthal)53yo maleMEWDSInfluenza (10 days)Daniel and Andrei (2015)9Daniel B. Andrei B. Clinic E. Street P.R. Acute Posterior Multifocal Placoid Pigment Epitheliopathy Following Influenza Vaccination.Rom J Ophthalmol. 2015; 59: 52-58PubMed Google ScholarAcute posterior multifocal placoid pigment epitheliopathy following influenza vaccination (Romanian J Ophthal)18yo femaleAPMPPEInfluenza (2 weeks)Gonome et al. (2016)10Gonome T. Suzuki Y. Metoki T. Takahashi S. Nakazawa M. Acute posterior multifocal placoid pigment epitheliopathy and granulomatous uveitis following influenza vaccination.Am J Ophthalmol Case Reports [Internet]. 2016; 4 (Available from): 60-63http://dx.doi.org/10.1016/j.ajoc.2016.08.008Crossref PubMed Scopus (14) Google ScholarAcute posterior multifocal placoid pigment epitheliopathy and granulomatous uveitis following influenza vaccination (Am J Ophthal Case Reports)Female in her 30sAPMPPEInfluenza (2 weeks) Open table in a new tab AIBSES remains a rare syndrome. The entity shares many features to other PICCPs, especially MEWDS with patient population, symptomatology, imaging findings and prognosis. There have been no previously reported cases of AIBSES following vaccination, but there have been cases of other PICCPs, namely MEWDS, APMPEE and MFC, following various vaccinations. Prognosis is generally favorable for AIBSES and other PICCPs. As this is an isolated case report describing a plausible relationship between AIBSES and MMR vaccination, causation cannot be established. More research needs to be done as the etiology of AIBSES and other PICCPs remain unknown, but vaccination history should be included in all patients with suspected PICCPs. Download .xml (.0 MB) Help with xml files
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