Age: 51.0
Sex: F
Vaccine: COVID19
Symptoms: Endocrine ophthalmopathy, Ophthalmological examination
Clinical narrative: This literature-non-study case was reported in a literature article and describes the occurrence of ENDOCRINE OPHTHALMOPATHY (Thyroid eye disease) in a 51-year-old female patient who received mRNA-1273 (Spikevax) for COVID-19 vaccination. LITERATURE REFERENCE: Teprotumumab in advanced reactivated thyroid eye disease. Case Rep;26:101484. The patient's past medical history included Thyroid eye disease (Patient has a 16-year history of thyroid eye disease) and Orbital decompression (Patient experienced another flare and subsequently underwent bilateral orbital decompressions). Previously administered products included for Thyroid eye disease: steroid therapy (The disease recurrence was refractory to intravenous steroid therapy and only partially responsive to oral steroid therapy). Past adverse reactions to the above products included Thyroid eye disease with steroid therapy. On an unknown date, the patient received second dose of mRNA-1273 (Spikevax) (unknown route) 1 dosage form. On an unknown date,  after starting mRNA-1273 (Spikevax), the patient experienced ENDOCRINE OPHTHALMOPATHY (Thyroid eye disease) (seriousness criterion medically significant). The patient was treated with TEPROTUMUMAB for Adverse event, at an unspecified dose and frequency and PREDNISONE (oral) for Adverse event, at an unspecified dose and frequency. At the time of the report, ENDOCRINE OPHTHALMOPATHY (Thyroid eye disease) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Ophthalmological examination: 27 mm od and 26 mm os 27 mm OD and 26 mm OS and 17 mm od, 17 mm os 17 mm OD, 17 mm OS. For mRNA-1273 (Spikevax) (Unknown), the reporter considered ENDOCRINE OPHTHALMOPATHY (Thyroid eye disease) to be related. Concomitant was not reported. Patient developed dysthyroid optic neuropathy in the right eye with decreased visual acuity and color vision. Clinical activity score was 8/10. The patient underwent treatment with eight infusions of teprotumumab coinciding with a low taper of oral prednisone and experienced resolution of dysthyroid optic neuropathy, decrease of clinical activity score to 1, and dramatic improvement in proptosis (17 mm OD, 17 mm OS) and extraocular muscle size on imaging. This case report suggests teprotumumab may be used in patients with reactivation of longstanding thyroid eye disease. Reduction of extraocular muscle size and improvement in proptosis suggest teprotumumab may be disease-modifying even in advanced cases. This literature non-study case concerns a 51 year old female patient with a 16-year history of thyroid eye disease previously treated with orbital decompression and multiple eyelid surgeries presented in a recurrent flare of the disease. The disease recurrence was refractory to intravenous steroid therapy and only partially responsive to oral steroid therapy, and the patient developed dysthyroid optic neuropathy in the right eye with decreased visual acuity and color vision. Clinical activity score was reported 8/10 and proptosis measurements were 27 mm OD and 26 mm OS. The patient underwent treatment with eight infusions of teprotumumab coinciding with a low taper of oral prednisone and experienced resolution of dysthyroid optic neuropathy, decrease of clinical activity score to 1, and dramatic improvement in proptosis (17 mm OD,17 mm OS) and extraocular muscle size on imaging.   Two weeks post vaccination with the 2nd dose of mRNA-1273 vaccine and  thirty weeks after completion of teprotumumab, she experienced Serious (Medically Significant), unexpected event of Endocrine ophthalmopathy (another flare) and subsequently underwent bilateral orbital decompressions. The outcome of the event was reported as unknown. The history of thyroid eye disease mentioned above and the treatment medication  teprotumumab are considered as a confounders for the event. The benefit -risk relationship of mRNA -1273 (Moderna Covid-19 Vaccine) is not affected by this report. The reviewer has limited information regarding this case  since the full text was not available at the time of the medical review. Sender's Comments: This literature non-study case concerns a 51 year old female patient with a 16-year history of thyroid eye disease previously treated with  orbital decompression and multiple eyelid surgeries presented in a recurrent flare of the disease. The disease recurrence was refractory to intravenous steroid therapy and only partially responsive to oral steroid therapy, and the patient developed dysthyroid optic neuropathy in the right eye with decreased visual acuity and color vision. Clinical activity score was reported 8/10 and proptosis measurements were 27 mm OD and 26 mm OS. The patient underwent treatment with eight infusions of teprotumumab coinciding with a low taper of oral prednisone and experienced resolution of dysthyroid optic neuropathy, decrease of clinical activity score to 1, and dramatic improvement in proptosis (17 mm OD,17 mm OS) and extraocular muscle size on imaging. Two weeks post vaccination with the 2nd dose of mRNA-1273 vaccine and  thirty weeks after completion of teprotumumab, she experienced Serious (Medically Significant), unexpected event of Endocrine ophthalmopathy (another flare) and subsequently underwent bilateral orbital decompressions. The outcome of the event was reported as unknown. The history of thyroid eye disease mentioned above and the treatment medication teprotumumab are considered as a confounders for the event. The benefit -risk relationship of mRNA -1273 ( Moderna Covid 19 Vaccine) is not affected by this report. The reviewer has limited information regarding this case since the full text was not available at the time of the medical review.