Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Bacterial test, Condition aggravated, Corneal endotheliitis, Corneal thinning, Iritis
Clinical narrative: This literature-non-study case was reported in a literature article and describes the occurrence of OPHTHALMIC HERPES ZOSTER (Severe exacerbation of herpes zoster keratitis), CONDITION AGGRAVATED (Severe exacerbation of herpes zoster keratitis), MYCOBACTERIUM CHELONAE INFECTION (Mycobacterium chelonae infection) and CORNEAL ENDOTHELIITIS (Endotheliitis) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. LITERATURE REFERENCE: Recurrence of herpetic keratitis after COVID-19 vaccination: A report of two cases. The patient's past medical history included COVID-19 (Patient experienced COVID-19 infection in March 2020 due to an illness with fever and cough and subsequent positive at-home COVID-19 antibody test) in March 2020 and Tarsorrhaphy (Patient had severe ocular involvement which could not be fully evaluated due to systemic status, and a left eye tarsorrhaphy was maintained through out 3 months of hospitalization). Previously administered products included for Shingles: Zostavax shingles vaccine (Patient had no ocular issues after Zostavax shingles vaccine) in 2017, Shingrix vaccine (Patient had no ocular issues after Shingrix vaccine) in 2019 and Shingrix vaccine (Patient had no ocular issues after Shingrix vaccine) in 2020. Past adverse reactions to the above products included No adverse event with Shingrix vaccine, Shingrix vaccine and Zostavax shingles vaccine. Concurrent medical conditions included Hypercholesterolemia, Hypothyroidism, Hodgkin's lymphoma, Herpes zoster ophthalmicus (Patient had developed herpes zoster ophthalmicus in left eye while completing chemotherapy for Hodgkin's lymphoma) since 1981, Guillain-Barre syndrome (Patient was hospitalized for 3 months with severe Guillain-Barre syndrome with full-body flaccid paralysis and respiratory compromise without intubation) since 1981 and Herpetic keratitis. Concomitant products included FLUOROMETHOLONE for Herpes zoster ophthalmicus. In January 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In February 2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. In 2021, the patient experienced OPHTHALMIC HERPES ZOSTER (Severe exacerbation of herpes zoster keratitis) (seriousness criterion medically significant), CONDITION AGGRAVATED (Severe exacerbation of herpes zoster keratitis) (seriousness criterion medically significant), MYCOBACTERIUM CHELONAE INFECTION (Mycobacterium chelonae infection) (seriousness criterion medically significant), CORNEAL ENDOTHELIITIS (Endotheliitis) (seriousness criterion medically significant), CORNEAL THINNING (Stromal thinning) and IRITIS (Iritis). The patient was treated with VALACICLOVIR (oral) ongoing from 2021 for Adverse event, at a dose of 1 gram twice a day; OFLOXACIN (ophthalmic) ongoing from 2021 for Adverse event, at a dose of 4 drop once a day; AMIKACIN (ophthalmic) from 2021 to 2021 for Adverse event, at a dose of UNK UNK, q wk. and AZITHROMYCIN (oral) from 2021 to 2021 for Adverse event, at a dose of 500 milligram once a week. At the time of the report, OPHTHALMIC HERPES ZOSTER (Severe exacerbation of herpes zoster keratitis) and CONDITION AGGRAVATED (Severe exacerbation of herpes zoster keratitis) had resolved and MYCOBACTERIUM CHELONAE INFECTION (Mycobacterium chelonae infection), CORNEAL ENDOTHELIITIS (Endotheliitis), CORNEAL THINNING (Stromal thinning) and IRITIS (Iritis) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In 2020, SARS-CoV-2 antibody test: positive (Positive). Patient had believed that patient experienced COVID-19 infection due to an illness with fever and cough. So patient had at-home COVID-19 antibody test, which was positive and had no ocular issues. In 2021, Bacterial test: stromal infiltrate vs. herpetic stromal keratitis A stromal infiltrate vs. herpetic stromal keratitis was present the subsequent week at which time bacterial corneal cultures were obtained. Cultures grew Mycobacterium chelonae. In 2021, Ophthalmological examination: 1x0.5 mm corneal epithelial defect. Corneal exam revealed 1x0.5 mm corneal epithelial defect without infiltrate suggestive of herpetic epithelial keratitis. In 2021, Polymerase chain reaction: inconclusive A swab of the corneal lesion was submitted for evaluation for herpes simplex virus (1 and 2) and varicella zoster virus by qualitative polymerase chain reaction. The test results were inconclusive due to a low number of cells detected in the specimen by the endogenous control. In 2021, Visual acuity tests: 20/150, Patient's visual acuity in the left eye had decreased to 20/150. On an unknown date, Visual acuity tests: 20/40 Patient had maintained 20/40 visual acuity with a clear cornea for over 10 years prior to the current event presentation. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter considered OPHTHALMIC HERPES ZOSTER (Severe exacerbation of herpes zoster keratitis), CONDITION AGGRAVATED (Severe exacerbation of herpes zoster keratitis), MYCOBACTERIUM CHELONAE INFECTION (Mycobacterium chelonae infection), CORNEAL ENDOTHELIITIS (Endotheliitis), CORNEAL THINNING (Stromal thinning) and IRITIS (Iritis) to be related. Patient had experienced blurry vision, redness, and abnormal sensation in left eye at the end of Jan-2021, just prior to second COVID-19 vaccination. In the past, patient had severe initial course of prophylactic bandage contact lens wear for neurotrophic corneal status. After treatment medication was started, while the ulcer resolved, the healing course was complicated by rogressive stromal thinning, iritis, Endotheliitis, and difficulty with corneal epithelial healing. Company comment: This literature-non-study case concerns a 67-year-old female patient, with medical history of Hodgkin's lymphoma, herpes zoster ophthalmicus (she had developed herpes zoster ophthalmicus in left eye while completing chemotherapy for Hodgkin's lymphoma) and herpetic keratitis, who experienced the serious (due to medically significant) unexpected events of OPHTHALMIC HERPES ZOSTER, CONDITION AGGRAVATED (reported as severe exacerbation of herpes zoster keratitis), MYCOBACTERIUM CHELONAE INFECTION, after the first dose of mRNA-1273 vaccine. As per source document, she experienced and abnormal sensation in her left eye approximately a month after vaccination. A corneal exam revealed a corneal epithelial defect suggestive of herpetic epithelial keratitis, so she started treatment with a bandage contact lens, valacyclovir and ofloxacin and continued with her baseline Fluorometholone. A corneal swab for herpes simplex was inconclusive but a week later Mycobacterium chelonae grew in corneal cultures. Amikacin drops and oral azithromycin were prescribed. While the ulcer resolved, the healing course was complicated by progressive stromal thinning, iritis, Endotheliitis, and difficulty with corneal epithelial healing. Patient´s age, history of Hodgkin's lymphoma, herpes zoster ophthalmicus and herpetic keratitis could be risk factors for OPHTHALMIC HERPES ZOSTER and CONDITION AGGRAVATED. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report. Most recent FOLLOW-UP information incorporated above includes: On 02-Jun-2022: Live follow up received by safety on 02-JUN-2022 has Email with FTA and  article propagated and contains significant information. Reporter's address, correspondence contact, additional authors, medical history, lab data, and dosage information updated. Sender's Comments: This literature-non-study case concerns a 67-year-old female patient, with medical history of Hodgkin's lymphoma, herpes zoster ophthalmicus (she had developed herpes zoster ophthalmicus in left eye while completing chemotherapy for Hodgkin's lymphoma) and herpetic keratitis, who experienced the serious (due to medically significant) unexpected events of OPHTHALMIC HERPES ZOSTER, CONDITION AGGRAVATED (reported as severe exacerbation of herpes zoster keratitis), MYCOBACTERIUM CHELONAE INFECTION, after the first dose of mRNA-1273 vaccine. As per source document, she experienced and abnormal sensation in her left eye approximately a month after vaccination. A corneal exam revealed a corneal epithelial defect suggestive of herpetic epithelial keratitis, so she started treatment with a bandage contact lens, valacyclovir and ofloxacin and continued with her baseline Fluorometholone. A corneal swab for herpes simplex was inconclusive but a week later Mycobacterium chelonae grew in corneal cultures. Amikacin drops and oral azithromycin were prescribed. While the ulcer resolved, the healing course was complicated by progressive stromal thinning, iritis, Endotheliitis, and difficulty with corneal epithelial healing. Patient´s age, history of Hodgkin's lymphoma, herpes zoster ophthalmicus and herpetic keratitis could be risk factors for OPHTHALMIC HERPES ZOSTER and CONDITION AGGRAVATED. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.