Sex: F
Vaccine: FLUX
Symptoms: Retinal exudates, Slit-lamp tests abnormal, Visual acuity reduced, Visual acuity tests abnormal, Visual field defect
Clinical narrative: Retinal white dots syndrome; photopsias/central flashing lights in her right eye; macular lesion/multiple round lesions in the posterior pole; enlarged blind spot in the right eye; mild residual RPE mottling; This case was reported in a literature article and described the occurrence of retinal white dots syndrome in a 27-year-old female patient who received Flu unspecified (Influenza vaccine) for prophylaxis.  The patient's past medical history included surgery (bilateral ureteral reimplantation surgery) and tonsillectomy. Concurrent medical conditions included stevens johnson syndrome (at the age of 2 years), wolff-parkinson-white syndrome, vesicoureteric reflux, chronic kidney disease (mild), endometriosis, fibroadenoma, depression, anxiety and allergy to antibiotic. Concomitant products included atenolol.   On an unknown date, the patient received Influenza vaccine at an unknown dose. On an unknown date, 14 days after receiving Influenza vaccine, the patient experienced retinal white dots syndrome (serious criteria GSK medically significant), photopsia, eye disorder, blind spot enlarged and retinal pigment epithelium atrophy. The patient was treated with Centrum Women. On an unknown date, the outcome of the retinal white dots syndrome, photopsia, eye disorder and blind spot enlarged were resolved with sequelae and the outcome of the retinal pigment epithelium atrophy was unknown.   The reporter considered the retinal white dots syndrome, photopsia, eye disorder, blind spot enlarged and retinal pigment epithelium atrophy to be possibly related to Influenza vaccine.  Additional information was provided.  This case was reported in a literature article and described the occurrence of multiple evanescent white dot syndrome (MEWDS) in a 27-year-old female patient who was vaccinated with unspecified influenza vaccine (manufacturer unknown) for prophylaxis.   The patient was single, worked as a clerk at a hospital. The patient had a history of Stevens-Johnson Syndrome (SJS) at age 2, Wolff-Parkinson-White Syndrome, vesicouretral reflux, mild chronic kidney disease, endometriosis, fibroadenomas, and depression with anxiety. Patient's past surgical history included bilateral ureteral reimplantation surgery and tonsillectomy. She reported allergies to multiple antibiotics. The patient did not smoke, drink, or use illicit drugs. There was no history of high-risk sexual activity. A comprehensive review of systems was negative for fever, rash, oral ulcers, arthralgias, headache, or vertigo. There was no history of recent viral illness. The patient was taking atenolol 25 mg as well as Centrum women's one a day. The patient was not a hepatitis carrier.  No information on patient's family history was provided.   On unspecified date, the patient had received intradermal unspecified influenza vaccine (site unspecified, dosage unknown; batch number not provided) at her place of employment. The age of vaccination was not provided.  On an unspecified date, 2 weeks following vaccination, the patient presented to clinic for the sudden onset of central flashing lights in her right eye (photopsias OD). She did not report any symptoms from her left eye. On examination, best-corrected visual acuity was 20/25-2 oculus dexter (OD) and 20/20 oculus sinister (OS) Pupil responses and intraocular pressures (12 mmHg) were normal bilaterally. Pupillary reaction, motility, and adnexa exam were unremarkable. A confrontation visual field test revealed central loss in the right eye and full visual field in the left eye. Slit lamp examination revealed 1+ anterior vitreous inflammation OD. Fundus examination of the right eye revealed scattered non-pigmented deep retinal or chorioretinal lesions in the posterior pole. The optic nerve appeared normal. Fundus examination OS was normal. Optical coherence tomography (OCT) cross-section of the retina demonstrated outer retinal and retinal pigment epithelium (RPE) irregularities. Fluorescein Angiography of the right eye showed multiple round lesions in the posterior pole with early hyper-fluorescence and late staining. Humphrey visual field testing revealed an enlarged blind spot in the right eye. Findings were consistent with MEWDS.   No treatment was prescribed.   On unspecified date, on follow up 8 weeks later, her visual symptoms had significantly improved. The macular lesions on exam had resolved with mild residual RPE mottling.  The author commented, "The relationship in this case may be coincidental, although her symptoms did start 2 weeks after vaccine administration. Also, our patient did have a history of SJS, an immune complex mediated hypersensitivity reaction, which may place her at higher risk for autoimmune conditions in general. Consistent with the natural history of MEWDS, her condition was self-resolving and did not require treatment. While rare, MEWDS can occur following influenza vaccination".  The article corresponding to this case is not available for submission due to copyright restriction.      Lab Comments: Lab tets were performed on unspecified date. On examination, best-corrected visual acuity was 20/25-2 oculus dexter (OD) and 20/20 oculus sinister (OS) Pupil responses and intraocular pressures (12 mmHg) were normal bilaterally. Pupillary reaction, motility, and adnexa exam were unremarkable. A confrontation visual field test revealed central loss in the right eye and full visual field in the left eye. Slit lamp examination revealed 1+ anterior vitreous inflammation OD. Fundus examination of the right eye revealed scattered non-pigmented deep retinal or chorioretinal lesions in the posterior pole. The optic nerve appeared normal. Fundus examination OS was normal. Optical coherence tomography (OCT) cross-section of the retina demonstrated outer retinal and retinal pigment epithelium (RPE) irregularities. Fluorescein Angiography of the right eye showed multiple round lesions in the posterior pole with early hyper-fluorescence and late staining. Humphrey visual field testing revealed an enlarged blind spot in the right eye. Findings were consistent with MEWDS.