Sex: F
Vaccine: FLU4
Symptoms: Corneal oedema, Culture positive, Eye pain, Herpes zoster, Herpes zoster reactivation
Clinical narrative: Purpureocillium lilacinum Keratitis; corneal ulcer; blurry vision; pain; photophobia of the affected eye; reactivation of herpes zoster dermatitis/of herpes zoster lesions on the flank; Initial information was received on 09-Nov-2020 regarding an unsolicited valid serious case from the other health care professional via a literature full article.   This case involves a 64 year old female patient who had purpureocillium lilacinum keratitis (keratitis fungal), reactivation of herpes zoster dermatitis/of herpes zoster lesions on the flank (herpes zoster reactivation), blurry vision (vision blurred), eye pain, photophobia of the affected eye (photophobia) and corneal ulcer (ulcerative keratitis), while she received vaccines INFLUENZA QUADRIVAL A-B VACCINE [FLUZONE QUADRIVALENT].  The patient's past medical treatment(s), vaccination(s) and family history were not provided.  At the time of the event, the patient had ongoing Herpes zoster and Herpes zoster.  Patient endorsed a history of soft contact lens misuse, including periodic extended and overnight contact lens wear. She denied trauma or exposure to vegetable matter.  On an unknown date, the patient received a dose of suspect INFLUENZA QUADRIVAL A-B VACCINE (lot number and expiry date not reported) via unknown route in unknown administration site for prophylactic vaccination.  On an unknown date, the patient developed a serious purpureocillium lilacinum keratitis (keratitis fungal), reactivation of herpes zoster dermatitis/of herpes zoster lesions on the flank (herpes zoster reactivation), blurry vision (vision blurred), eye pain, photophobia of the affected eye (photophobia) and corneal ulcer (ulcerative keratitis), unknown latency following the administration of INFLUENZA QUADRIVAL A-B VACCINE [FLUZONE QUADRIVALENT]. These events was assessed as medically significant.   On an unknown date, the patient developed a non serious reactivation of herpes zoster dermatitis/of herpes zoster lesions on the flank (herpes zoster reactivation) unknown latency following the administration of INFLUENZA QUADRIVAL A-B VACCINE [FLUZONE QUADRIVALENT].  Relevant laboratory test results included: On an unknown date Purpureocilium lilacinum keratitis culture showed positive and slit-lamp examination showed left eye revealed a central corneal infiltrate with feathery borders measuring 2.4 mm x 2.0 mm with an overlying epithelial defect with associated satellite lesions, 2plus stromal edema, and presence of keratic precipitates with hypopyon inferiorly. On examination, the patient's best corrected visual acuity was 20/20 in the right eye and 20/400 in the left eye. Examination of the right eye was unremarkable  Routine corneal scrapings were performed using blood, chocolate, Sabourads and non-nutrient agars, as well as thioglycolate broth.  Empirical treatment with hourly fortified vancomycin and tobramycin was initiated, along with oral valacyclovir. Three days later, the preliminary corneal cultures on blood and Saborauds agars revealed fungal elements. Fortified antibiotics were decreased and the patient was started on hourly topical voriconazole. Final culture and speciation results indicated Purpureocillium lilacinum as the causative agent. After approximately 3 months of voriconazole monotherapy, the infiltrate regressed, leaving behind a partially light-blocking anterior stromal scar.   The patient was treated with VANCOMYCIN (VANCOMYCIN) and TOBRAMYCIN (TOBRAMYCIN),along with oral valacyclovir 1 gram three times daily. The patients best corrected visual acuity improved to 20/25 in the left eye.  At the time of reporting, the outcome of event was recovering.  Information on lot number was requested for this case.; Sender's Comments: This case concerns a 64 year old female patient who had keratitis fungal, herpes zoster reactivation,vision blurred, eye pain, photophobia and ulcerative keratitis after vaccination with FLUZONE QUADRIVALENT. The time to onset is unknown. Additional information regarding medical history, condition at the time of vaccination, lab data excluding other predisposing etiologies would be needed for complete assessment of the case. Based upon the reported information, the role of the suspect vaccine cannot be assessed.