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Case Reports
. 2022 Apr 10:26:101516.
doi: 10.1016/j.ajoc.2022.101516. eCollection 2022 Jun.

Vogt-Koyanagi-Harada disease following influenza vaccination

Fahmeeda Murtaza  1 , Austin Pereira  2 , Mark S Mandelcorn  2   3 , Alexander J Kaplan  2   3
Affiliations
Case Reports

Vogt-Koyanagi-Harada disease following influenza vaccination

Fahmeeda Murtaza et al. Am J Ophthalmol Case Rep. .

Abstract

Purpose: To report a case of Vogt-Koyanagi-Harada (VKH) disease following influenza vaccination.

Observations: A 30-year-old Filipino male developed bilateral pain, redness, photophobia, floaters, headache and tinnitus 2 days after receiving the annual influenza vaccine. He presented to the emergency department 5 days after symptom onset. His past medical and ocular history was unremarkable. His best-corrected distance visual acuity (BCVA) was 20/100 in the right eye (OD) and 20/150 in the left eye (OS). Slit-lamp examination revealed fine keratic precipitates and 1+ anterior chamber cells in both eyes (OU). Dilated fundus examination revealed 1+ vitreous cells with trace haze and multiple serous retinal detachments OU. Magnetic resonance imaging (MRI) of the brain and chest X-ray were unremarkable. Serologic testing was negative for infectious, inflammatory and neoplastic causes. The patient tested positive for HLA-DR4. A diagnosis of acute Vogt-Koyanagi-Harada disease was made and high-dose oral prednisone, intravitreal triamcinolone acetonide and mycophenolate mofetil were needed to achieve quiescence. At 6 months follow-up, our patient remains in remission with no active intraocular inflammation or subretinal fluid. His BCVA has improved to 20/50 OD and 20/30 OS.

Conclusion and importance: The annual influenza vaccine may be a trigger for onset or recurrence of VKH in genetically susceptible individuals.

Keywords: HLADR4; Influenza vaccination; Uveitis; VKH; Vaccine; Vogt-Koyanagi-Harada.

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Figures

Fig. 1
Fig. 1
Fundus photos showing bilateral serous retinal detachments in the right (A) and left (B) eye and fundus auto-fluorescence images demonstrating hyper-autofluorescence over areas of serous retinal detachments in the right (C) and left (D) eye. Spectral-domain optical coherence tomography images demonstrating multiple pockets of subretinal and intraretinal fluid with secondary choroidal thickening in the right (E) and left (F) eye.
Fig. 2
Fig. 2
Late frame fluorescein angiography of the (A) right and (B) left eye 2 weeks following the influenza vaccine demonstrating multiple pinpoint hyperfluorescent spots pooling into subretinal space.
Fig. 3
Fig. 3
Fundus autofluorescence images reveal multiple punctate hyper and hypo autofluorescent spots correlating to areas of outer retinal atrophy in the right (A) and left (B) eye. Spectral-domain optical coherence tomography images show resolution of subretinal fluid and a transmission defect from outer retinal atrophy (white arrows) in the right (C) and left (D) eye.
See this image and copyright information in PMC

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