Recurrent bilateral idiopathic anterior uveitis with vitritis post Coronavirus Disease 2019 infection

Kawali

Mahendradas

2023

Self Cite

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.

Section: Discussionmentioning

confidence: 99%

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

Kawali

Mahendradas

2023

Self Cite

“…A patient with recurrent anterior uveitis with vitritis and no systemic clue except raised SARS-CoV-2 antibodies had been reported earlier. [ 6 ] The patient’s ocular inflammation had been well controlled with weekly dose of oral methotrexate 25mg and oral sulfasalazine 1 g twice daily and folic acid 5 mg folic acid on days when methotrexate was not administered. She was administered the first dose of coronavirus vaccination (COVISHIELD™) on May 30, 2021, and she developed fever a day later with no eye symptoms.…”

Section: Case Reportmentioning

confidence: 99%

COVID-19 vaccination and recurrent anterior uveitis

Yathish

Singh

et al. 2022

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A 35-year-old Asian Indian female previously diagnosed with bilateral anterior uveitis and on oral methotrexate developed bilateral anterior uveitis following first/second dose of coronavirus disease 2019 (COVID-19) vaccination. She had skipped her weekly dose of oral methotrexate following first dose of vaccination. Following the second dose, she reduced her oral methotrexate from 25 to 15 mg on her own, but did not stop like the previous occasion. She had extensive workup for her uveitis in the past with only positive severe acute respiratory syndrome coronavirus (SARS-CoV-2) antibodies. She developed unilateral anterior uveitis after she had COVID-19 in July 2022, which resolved with topical steroids and continuation of immunosuppression. This report illustrates that COVID-19 or its vaccination may presumably play a role in triggering the immune system and can cause recurrent ocular inflammation even in the absence of an extraocular inflammation.

“…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 ]…”

mentioning

confidence: 99%

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

Kundu

Deshpande

et al. 2023

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To demonstrate viral proteins/inflammatory cytokines in a patient with unilateral keratouveitis. Retrospective case report. A 70-year-old Asian-Indian male presented with acute onset of blurring of vision in the left eye (OS) of 2 days duration. He had was coronavirus disease 2019 (COVID-19)-positive 3 months earlier. He had undergone cataract surgery/retinal laser photocoagulation in both the eyes. The corrected distance visual acuity (CDVA) (Snellen) in the right eye (RE) (OD) and left eye (LE) (OS) was 20/20 and 20/80, respectively. OS showed decreased corneal sensation, Descemet’s folds, mild stromal edema, and fine and pigmented keratic precipitates with anterior chamber 1+ flare and 1+ cells. Fundus evaluation showed scattered laser marks in the OD and temporal sectoral laser marks in OS. He was diagnosed with viral keratouveitis in OS. Tear samples were collected on Schirmer’s strips and tear wash for mass spectrometry and cytokines, which had 368 and 451 viral proteins in the RE and LE, respectively, using nano liquid chromatography–mass spectrometry, which were more than controls. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and varicella zoster virus proteins were detected. Cytokine analysis using flow cytometer analysis showed higher inflammation in OS as compared to OD. The patient was treated with oral acyclovir and topical steroids and resulted in resolution of his keratouveitis. SARS-CoV-2 proteins were present in the tear sample 3 months after COVID-19. The presence of viral proteins does not indicate causality.