Acute Posterior Multifocal Placoid Pigment Epitheliopathy After Immunization With Multiple Vaccines

Abstract

Purpose: To report a case of acute posterior multifocal placoid pigment epitheliopathy occurring in temporal association with multiple immunizations in a previously healthy 25year-old woman.Methods: Acute posterior multifocal placoid pigment epitheliopathy was diagnosed based on ophthalmological findings of bilateral placoid subretinal lesions complicated by a serous retinal detachment in the left eye.Results: Through HLA typing, the patient was found to possess the HLA-B*40 and HLA-DB1*15 alleles. She was treated with topical prednisolone acetate 1% and monitored for several months. The serous retinal detachment resolved, and visual acuity returned to normal.Conclusion: This case report adds to the body of knowledge regarding possible atypical interplay between vaccines and specific T-cell receptors of the host immune system and adds Polio and Tetanus to the growing list of vaccines potentially triggering acute posterior multifocal placoid pigment epitheliopathy. Increased awareness of the presentation of acute posterior multifocal placoid pigment epitheliopathy and that it may arise after immunization may also improve evaluation of acute changes in visual acuity.

Association between Vaccination with the BNT162b2 mRNA Coronavirus Disease 2019 Vaccine and Noninfectious Uveitis

“…16 , 35 , 36 , 37 Reports were mainly of anterior uveitis, but other cases included acute posterior multifocal placoid pigment epitheliopathy, VKH or MEWDS. 14 , 38 , 39 , 40 , 41 , 42 …”

Acute posterior multifocal placoid pigment epitheliopathy (APMPPE)

“…An increased incidence of both class I HLA antigen (HLA-B7) and class II HLA antigen (HLA-DR2) with a relative higher risk of 3.38 and 3.32 of developing ocular disease, respectively, has been reported in APMPPE patients [17]. The immune driven nature is also supported by the development of the disease after immunization with vaccines, including hepatitis B, varicella, polio, and tetanus, suggesting a possible interplay between vaccines and specific T-cell receptors of the host immune system [18][19][20][21][22][23].…”

Bilateral acute posterior multifocal placoid pigment epitheliopathy (APMPPE) following SARS-CoV-2 mRNA vaccine

“…1 9 Neurological symptoms such as headache and sensorineural hearing loss may require imaging to rule out CNS vasculitis. 10 Hallmark clinical features include bilateral, multiple, large (1-2 disc diameters), creamy yellowwhite placoid lesions at the level of RPE and choroid throughout the posterior pole. 8 Associated findings may include mild anterior uveitis/vitritis/…”

“…One-third of APMPPE cases experience a viral prodrome prior to APMPPE symptom onset 1 9. Neurological symptoms such as headache and sensorineural hearing loss may require imaging to rule out CNS vasculitis 10…”