Age: 33.0
Sex: M
Vaccine: TYP
Symptoms: Visual field tests normal, Vitreous floaters
Clinical narrative: These case reports were previously actioned by Crucell (BERNA-2013-0296). The data was taken directly from the database repository and entered verbatim (including labeling and causality assessments) on to the safety database. Where labeling and causality assessments were absent, facility took the decision to assign according to company guidelines. This literature case was forwarded by Novartis with the reference number: PHHY2013US017448. An initial report was received on 18.FEB.2013 and concerns a previously healthy 33-year-old male patient, who on an unspecified date received typhoid vaccine (manufacturer and batch number: not reported) as a prophylactic vaccination. On the same day, the patient also received inactivated hepatitis A and yellow fever vaccination (manufacturer and batch number: not reported). It was noted that the patient had previously received one dose of hepatitis A vaccine 12 years ago (he did not complete the series). On an unspecified date, 3 weeks after vaccination, the patient suddenly experienced intermittent floaters and flashing lights in his right eye and was referred to retina service. The examination showed visual acuity at 20/20 in both eyes. Pupil responses, visual fields to confrontation, and intraocular pressure (14 mmHg) were normal bilaterally. A slit lamp examination revealed 1+ anterior vitreous inflammation bilaterally. Fundus examination of the right eye revealed a few scattered peripheral non-pigmented chorioretinal lesions. The macula and optic nerve appeared to be normal and the left fundus was unremarkable. A fluorescein angiography of the right eye showed scattered peripheral hyperfluorescent lesion correlating with those seen in the fundus, and there was no evidence of disc leakage. A comprehensive review of systems was negative for fever, rash, oral ulcers, arthralgia, headache or vertigo. There was no history of autoimmune disease or recent viral illness. There was no family history of autoimmune disease. On an unspecified date, the patient was diagnosed with an acute multifocal choroiditis. After 2 weeks, the patient still experienced occasional floaters. His ocular examination revealed continued low grade anterior vitreous inflammation and the peripheral retinal lesions began to demonstrated early hyperpigmentation. Because of the non-progressive examination findings and given the excellent visual acuity, it was decided to continue close observation. The authors concluded that this is the first reported case of multifocal choroiditis following vaccination. Although this case dose not prove causation and the relationship remains presumptive, it does suggest that some vaccinations can act as trigger for immunologic initiation that could subsequentely lead to the development of non infectious uveitis. The patient recovered on an unspecified date, 8 weeks after the occurrence of the event. It was noted that the vitreous was clear of cellular inflammation, and the fundus revealed punched out areas of retinal pigment epithelium atrophy. The case was considered serious (medically significant). No further information was reported for this case. Follow-up information was downloaded on VAERS database on 16.Apr.2013: The VAERS number 486128 was added to the case. The report did not contain any new information. Follow-up information received on 06.May.2013: It was mentioned that the patient had never before been exposed to typhoid or yellow fever immunizations. The Typhoid vaccine given orally to the patient was Vivotif. Case updated on 11.Mar.2014: The reference was rewritten, vaccine history added, test details appended and duration of the reaction inserted.