COVID-19 vaccination, dengue hepatitis, and recurrent unilateral anterior uveitis

Abstract

A 36-year-old Asian Indian male presented with redness and pain in his right eye of 1 week duration. He was diagnosed to have right acute anterior uveitis and had a history of being admitted at a local hospital for dengue hepatitis a month earlier. He had been on adalimumab 40 mg three weekly once and oral methotrexate 20 mg/week for human leucocyte antigen (HLA) B27 spondyloarthropathy and recurrent anterior uveitis. Our patient had re-activation of his anterior chamber inflammation on three distinct occasions: first, 3 weeks following recovery from coronavirus disease 2019 (COVID-19), the second after the second dose of COVID-19 vaccination, and the third after recovery from dengue fever-associated hepatitis. We propose molecular mimicry and bystander activation as the postulated mechanisms for the re-activation of his anterior uveitis. In conclusion, patients with auto-immune diseases can have recurrent ocular inflammation following COVID-19 or its vaccination or dengue fever as seen in our patient. The anterior uveitis is usually mild and responds to topical steroids. Additional immuno-suppression may not be needed. Mild ocular inflammation following vaccination should not deter individuals from getting COVID-19 vaccination.

Coronavirus disease 19 (COVID-19) and viral keratouveitis – unraveling the mystery

“…Post-coronavirus disease 2019 (COVID-19) ocular manifestations reported in the medical literature include conjunctivitis, anterior uveitis, sclero-uveitis, reactivation of quiescent anterior uveitis, vitritis, pan uveitis, cotton wool spots, retinal hemorrhages, retinal artery and vein occlusion, ophthalmic artery occlusion, papillophlebitis, multi-focal chorioretinitis, central serous chorioretinopathy, and Adie’s syndrome. [ 1 2 3 4 5 6 7 ] Herpes zoster/Herpes zoster ophthalmicus (HZ/HZO) have been reported in patients following COVID-19. [ 8 9 ]…”