Bilateral Optic Neuritis and Hypophysitis With Diabetes Insipidus 1 Month After COVID-19 mRNA Vaccine: Case Report and Literature Review

Abstract

Either optic neuritis (neuropathy) or hypopituitarism has been known to occur separately after COVID-19 vaccination. In this report, we describe the rare combination of hypophysitis and optic neuritis which occurred after COVID-19 vaccination. A 74-year-old woman began to have thirst, polydipsia, and polyuria, and was diagnosed as central diabetes insipidus 1 month after the fourth COVID-19 mRNA vaccine. Head magnetic resonance imaging (MRI) disclosed the thickened pituitary stalk and enlarged pituitary gland with high contrast enhancement as well as the absence of high-intensity signals in the posterior pituitary lobe on the T1-weighted image, leading to the diagnosis of lymphocytic hypophysitis. She was well with desmopressin nasal spray until further 2 months later, when she developed bilateral optic neuritis, together with gait disturbance, intention tremor of the upper extremities, urinary retention, constipation, abnormal sensation in the distal part of the lower extremities, and moderate hemiplegia on the left side. Autoantibodies, including anti-aquaporin 4 (AQP4) and anti-myelin oligodendrocyte glycoprotein (MOG), were all negative. She showed multifocal spinal cord lesions on MRI and oligoclonal bands in the cerebrospinal fluid obtained by spinal tap, and so underwent steroid pulse therapy with methylprednisolone in the tentative diagnosis of multiple sclerosis, resulting in visual acuity recovery and alleviation of neurological symptoms. In the literature review, the combination of optic neuritis and hypophysitis, mostly with diabetes insipidus, was reported in 15 patients as case reports before the years of COVID-19 pandemic. The COVID-19 vaccination would trigger the onset of hypophysitis and optic neuritis in this patient.

Vogt‐Koyanagi‐Harada disease in pregnancy: Case report and review of 32 patients in the literature

“…She did not suffer from COVID‐19 and did not undergo vaccines for COVID‐19, based on her choice. Vaccination for COVID‐19 has been known as a precipitating factor for the development of uveitis, 47 retinal and vitreous hemorrhages, 48 and optic neuritis 49,50 . Vogt‐Koyanagi‐Harada disease is a most prevalent entity of uveitis among various entities of uveitis which develop or relapse after vaccination for COVID‐19 in the Japanese population 51 .…”

“…Vaccination for COVID-19 has been known as a precipitating factor for the development of uveitis, 47 retinal and vitreous hemorrhages, 48 and optic neuritis. 49,50 Vogt-Koyanagi-Harada disease is a most prevalent entity of uveitis among various entities of uveitis which develop or relapse after vaccination for COVID-19 in the Japanese population. 51 In the present patient, there was no prodromal symptoms such as viral infection including COVID-19 infection and vaccinations.…”

A review of neuro-ophthalmic sequelae following COVID-19 infection and vaccination

“…The average time to symptom onset is 37 days (range 0.08 days (2 hours) to 180 days) following vaccination. Four cases were suspected of optic neuritis secondary to multiple sclerosis based on neuroimaging and CSF findings ( Matsuo et al., 2023 ; Shemer et al., 2023 ). IVMP was commenced for all 27 cases, with three cases further requiring PLEX ( Helmchen et al., 2022 ; Bhatti et al., 2023 ; Shemer et al., 2023 ).…”

SARS-CoV-2 Vaccines-Related Endocrine Disorders: An Updated Narrative Review

“…Hypophysitis following SARS-CoV-2 vaccine present most often as isolated arginine vasopressin (AVP) deficiency (central diabetes insipidus) due to infundibuloneurohypophysitis [89,[97][98][99]. AVP deficiency was also reported with subsequent development of optic neuritis [100]. Rarely, a concomitant anatomic and functional involvement of the anterior pituitary is present [101,102].…”