Multiple Evanescent White Dot Syndrome after Human Papillomavirus Vaccination

Abstract

Although the cause of multiple evanescent white dot syndrome (MEWDS) has not been elucidated, 2 reports have described cases of MEWDS after vaccination. A 16-year-old girl presented with throat pain, headache, and photopsia in the left eye 2 weeks after receiving a human papillomavirus (HPV) vaccination. The clinical examination revealed numerous white dots on the fundus, visual field loss, and abnormal electroretinography results, which are concordant with a diagnosis of MEWDS. Although the white dots on the fundus disappeared within a few months, her visual field continued to deteriorate progressively over 1.5 years of follow-up. Images obtained by fundus autofluorescence and optical coherence tomography revealed longitudinal changes consistent with the observed functional losses. Immunosuppressive therapy (betamethasone 200 mg/day) resulted in the complete resolution of all fluorescein leakage from the retinal vasculature. Maintenance betamethasone treatment (0.5 mg/day) led to visual field results over a period of 6 months. In this case of MEWDS, subsequent to HPV vaccination, the results of fluorescein angiography showed a marked response to immunosuppressive therapy. These findings support the hypothesis that MEWDS is associated with an impaired immune function.

Multimodal Imaging in an Unusual Cluster of Multiple Evanescent White Dot Syndrome

“…Given that characteristic white dots were not present in four patients (patients 1, 4, 5, and 6), we were guided by other fundus features, in particular foveal granularity, symptoms, multimodal imaging, and clinical course. While the presumed pathogenesis of MEWDS involves a viral infection, only few reports to date have described a search for the pathogen [5,[17][18][19]. The present cluster of cases provided us with a unique opportunity to seek a common viral denominator.…”

Multiple evanescent white dot syndrome following influenza immunization - A multimodal imaging study

“…To the best of our knowledge, there have been eight published case of MEWDS following various vaccinations, including rabies, 7 human papilloma virus, 8 , 9 hepatitis A, 6 , 10 hepatitis B, 11 meningococcal, 8 Yellow fever, 6 and influenza. 4 , 5 The demographics and clinical course of all published cases.…”

“…To the best of our knowledge, eight cases of vaccination-associated multiple evanescent white dot syndrome (MEWDS) have been reported previously. 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 We add here the description of a ninth case of MEWDS following immunization with inactivated intra-dermal influenza virus, and include for the first time full multimodal imaging (MMI) of such a case. Characteristics and outcomes of all nine cases are summarized and compared.…”

Vaccine-Associated Uveitis

“…The patient improved and all findings resolved over eight weeks without treatment. The authors cited three previously published cases of MEWDS following vaccination: one after combined HAV and yellow fever vaccine 28 ; a second following HPV vaccine 29 ; and a third after influenza vaccine. 30 Although not cited, MEWDS has also been reported following HBV vaccine by Baglivo et al, 31 after HAV vaccine by Fine et al, 32 and following rabies vaccine by Yang et al 33 Posterior placoid lesions in the spectrum of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) have also been associated with immunization.…”