Acute dacryoadenitis in a patient with SARS-CoV-2 infection

A 14-year-old boy was referred to the ophthalmology department with a 4-day history of rapid-onset right upper lid pain, swelling and erythema starting 9 hours after his first dose of COVID-19 mRNA vaccination (BNT162b2/Comirnaty, Pfizer-BioNTech). On examination, he had significant right upper lid ptosis, oedema and erythema, with associated limitation of right eye abduction and elevation. He was found to have acute dacryoadenitis with orbital inflammatory disease on clinical and laboratory investigations. He was given tapering oral prednisone and had full resolution of symptoms within 2 weeks. This is the first known case of orbital inflammation after COVID-19 mRNA vaccination. Given the temporal association between the patient’s vaccination and symptom onset, we believe it is likely that immunisation prompted the onset of disease.

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“…Acute dacryoadenitis is characterised by rapid enlargement of the lacrimal gland. It is often caused by viral or autoimmune disease 2…”

Section: Introductionmentioning

confidence: 99%

Acute-onset dacryoadenitis following immunisation with mRNA COVID-19 vaccine

et al. 2022

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“…5 Martínez Díaz et al recently reported one case of inflammatory dacryoadenitis in a 22-year-old patient. 9 The patient had an elevated c-reactive protein; otherwise, serologic work-up was unremarkable. Similar to our case, the patient did not respond to systemic antibiotic therapy but improved markedly with systemic corticosteroids.…”

Section: Discussionmentioning

confidence: 96%

Suspected orbital myositis associated with COVID-19

Armstrong

Murchison

Bilyk

2021

Orbit

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A 44-year-old male patient developed proptosis, edema, and erythema progressing to complete ptosis and supraduction deficit 2 days after positive COVID-19 test. He failed to improve on systemic antibiotics. MRI showed thickening and T2 enhancement of the superior rectus/levator complex consistent with orbital myositis. He improved on intravenous corticosteroids and experienced continued gradual improvement on oral steroids.

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“…[3][4][5] Three cases of orbital inflammation in the context of SARS-CoV-2 infection have been reported. 6,7 Turbin and colleagues 6 reported 2 adolescent patients presenting with unilateral orbital cellulitis, sinusitis, and radiographic intracranial abnormalities with relatively mild systemic manifestations. SARS-CoV-2 samples were positive confirming COVID-19 infection.…”

Section: Discussionmentioning

confidence: 99%

“…They hypothesized that SARS-CoV-2 infection resulted in congested upper respiratory tract and compromised mucociliary clearance, leading to secondary bacterial infection with subsequent orbital cellulitis with intracranial extension. Diaz and colleagues 7 reported a 22-year-old man patient who presented with unilateral acute dacryoadenitis, which was complicated by partial ophthalmoplegia and orbital inflammation despite oral antibiotic therapy and nonsteroidal antiinflammatory medications. The patient improved rapidly a few days after oral steroid therapy was initiated.…”

Section: Discussionmentioning

confidence: 99%