Age: 25.0
Sex: F
Vaccine: COVID19
Symptoms: Angiogram retina, Angiotensin converting enzyme, Chest X-ray, Erythema, Interferon gamma release assay
Clinical narrative: bilateral panuveitis; skin erythema; This literature-non-study case was reported in a literature article and describes the occurrence of UVEITIS (bilateral panuveitis) in a 25-year-old female patient who received mRNA-1273 (Spikevax) for COVID-19 prophylaxis. The occurrence of additional non-serious events is detailed below.   LITERATURE REFERENCE:    The patient's past medical history included Granulomatous inflammation (biopsy-proven granulomatous tattoo inflammation). Previously administered products included for Granulomatous inflammation: triamcinolone. Past adverse reactions to the above products included No adverse event with triamcinolone.    On an unknown date, the patient received second dose of mRNA-1273 (Spikevax) (unknown route) 1 dosage form. On an unknown date, the patient experienced UVEITIS (bilateral panuveitis) (seriousness criterion medically significant) and ERYTHEMA (skin erythema). The patient was treated with PREDNISONE for Intraocular inflammation, at an unspecified dose and frequency and MYCOPHENOLATE MOFETIL at an unspecified dose and frequency. At the time of the rep  DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Angiogram retina: Late phase fluorescein angiogram showed diffuse leakage at the level of the retinal pigment epithelium and disc leakage. The findings were similar, but less severe, in the left eye.. On an unknown date, Angiotensin converting enzyme: Normal. On an unknown date, Chest X-ray: Normal. On an unknown date, Interferon gamma release assay: (Negative) for syphilis, bartonella, and toxoplasmosis were negative. On an unknown date, Ophthalmological examination: Acuity was 20/25 OD and 20/20 OS, Anterior examination revealed 3 plus anterior chamber cells, keratic precipitates, posterior synechia, and 1 plus anterior vitreous cells bilaterally, Posterior examination showed peripheral punctate white retinal lesions bilaterally and Examination revealed bilateral panuveitis. On an unknown date, Retinogram: Fundus photograph of the right eye showed multiple small round white retinal inflammatory lesions, mainly in the inferior periphery. There was a small retinal hemorrhage along the superior arcade and disc edema. One of the retinal lesions was shown under high magnification.. On an unknown date, Serology test: (Negative) serologic testing for syphilis, bartonella, and toxoplasmosis were negative.     For mRNA-1273 (Spikevax) (Unknown), the reporter considered UVEITIS (bilateral panuveitis) to be related. No further causality assessment was provided for ERYTHEMA (skin erythema).    No concomitant medication was reported.  Patient developed bilateral eye pain and blurred vision one week following her second mRNA-1273 COVID-19 vaccination. Examination revealed bilateral panuveitis. Work up for infectious etiologies and sarcoidosis was negative. The intraocular inflammation initially resolved with systemic prednisone therapy, but then recurred following tapering of the prednisone, requiring the initiation of mycophenolate mofetil.  Three months previously, before her first vaccine, she had an indurated rash of the black ink of her forearm tattoos, which she had received between one and five years prior. Punch biopsy revealed lymphohistiocytic infiltrate with nonsuppurative granuloma formation associated with the black pigment and she was treated with intralesional triamcinolone. She had persistent mild skin erythema after receiving her vaccines. The patient did not note worsening of the skin reaction following the vaccination, however any potential worsening might have been masked by prior intralesional steroid treatment. Possible linkages between vaccination and stimulation of ocular autoimmunity in the setting of tattoo inflammation require further investigation.   Author reported that, the temporal relationship between the vaccine and the development of uveitis in this patient might be coincidental and should be interpreted with caution, but multiple vaccines have been associated with uveitis, presumably due to their generalized stimulation of the immune system. Author believed that this case of tattoo-associated uveitis may have been exacerbated by the generalized inflammatory effect of COVID-19 vaccination.  Company comment: This literature non study case concerns a 25-year-old, female patient with medical history of Granulomatous inflammation (biopsy-proven granulomatous tattoo inflammation), who experienced the unexpected serious (medically significant) event of bilateral panuveitis and non serious event of erythema. The event of panuveitis occurred approximately one week after the second dose of mRNA-1273. As reported, before patient's first vaccine, she had an indurated rash of the black ink of her forearm tattoos, which she had received between one and five years prior. Punch biopsy revealed lymphohistiocytic infiltrate with nonsuppurative granuloma formation associated with the black pigment and she was treated with intralesional triamcinolone. She had persistent mild skin erythema after receiving her vaccines. Patient's prior medical history of skin reactions to tattoo ink was discussed by the authors as potential explanation for latter occurrence of pan uveitis as tattoo-associated uveitis, however, role of vaccination in exacerbation of mentioned condition by the generalized inflammatory effect of COVID-19 vaccination as well as contributing role of vaccination itself was also considered. The benefit-risk relationship of mRNA-1273 is not affected by this report.