Yellow-fever vaccine
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Type IV hypersensitivity manifested as acute panuveitis and chorioretinal changes: case report A 50-year-old woman developed type IV hypersensitivity manifested as acute panuveitis and chorioretinal changes following vaccination with yellow-fever vaccine. The woman, who had no previous systemic or ocular diseases, received a single dose of yellow-fever vaccine [route and dosage not stated] in April 2017. After 4 days of vaccination, she presented with fever, nausea and hyporexia. Laboratory studies revealed leucopenia, thrombocytopenia, elevated CRP, urea and creatinine, haematuria, leucocyturia, jaundice and slightly elevated liver enzymes. She was admitted to the ICU for monitoring and support measures. About 12 days after the onset of symptoms, she experienced bilateral blurred vision. On ophthalmological examination, bestcorrected visual acuity was found to be 20/30 in left eye and 20/20 in right eye, and intraocular pressure was normal bilaterally. Further examination showed fine keratic precipitates scattered throughout the cornea and bilateral mild vitritis. Late-stage fluorescein angiography revealed focal hyper-fluorescence dots at the posterior pole in the left eye and fundus auto-fluorescence showed widely dispersed hypoauto-fluorescent dots, which were more notable ipsilaterally. Cross-sectional optical coherence tomography (OCT) revealed bilateral epiretinal membranes. Structural en-face OCT demonstrated diffuse hypo-reflective dots at the level of the choriocapillaries with decreased vessel density at the same location. Consequently, a diagnosis of type IV hypersensitivity manifested as bilateral asymmetric diffuse uveitis (acute panuveitis) and chorioretinal changes were made. The woman was treated with prednisone. After a week, she was re-evaluated with same findings and after every 2 weeks with progressive improvement. After 40 days, inflammation signs dissipated. As a result, fundus imaging improved. During this period, vascular changes and remission of the changes in the choriocapillaris were not observed, and her visual complaints resolved. Author comment: "We present a case of a rare adverse reaction to yellow fever vaccine in which a patient developed acute panuveitis." "Clinicians should be aware of clinical and subclinical ocular manifestations such as subtle puntiform choriocapillaris changes as possible vaccine-related adverse events with potential to impact vision." "The possible etiologies of our patient’s reaction include a type IV hypersensitivity to the vaccine". Marinho PM, et al. Diffuse uveitis and chorioretinal changes after yellow fever vaccination: A re-emerging epidemic. International Journal of Retina and Vitreous 5: No. 30, 7 Oct 2019. Available from: URL: http://doi.org/10.1186/ 803436954 s40942-019-0180-0 - Brazil
0114-9954/19/1781-0001/$14.95 Adis © 2019 Springer Nature Switzerland AG. All rights reserved
Reactions 30 Nov 2019 No. 1781
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