Sex: F
Vaccine: FLUX
Symptoms: Evans syndrome, Eye movement disorder, Photopsia, Retinal disorder, Vitreous disorder
Clinical narrative: Multiple Evanescent White Dot Syndrome; A Confrontation Visual Field test revealed central loss in the right eye and full visual field in the left eye; anterior vitreous inflammation of oculus dextrus (OD); retinal pigment epithelium (RPE) irregularities; central flashing lights in her right eye, Photopsia of oculus dextrus (OD); nonpigmented deep retinal or chorioretinal lesions in the posterior pole; enlarged blind spot in the right eye; Initial information received on 06-Jan-2020 regarding an unsolicited valid serious case issued from a physician via literature full article  The following is the abstract from the article: 27-year-old female presented to clinic with photopsias OD. Her symptoms began 2 weeks following intradermal influenza vaccination. Fundus examination and diagnostic testing were consistent with MEWDS. This is a report of MEWDS following intradermal influenza vaccination. Influenza vaccination is recommended for the elderly, pregnant, and patients with asthma, in addition to other high-risk groups. During the 2015-2016 flu season, over 146 million doses were distributed.2 Influenza vaccination is safe, widely administered, and welltolerated with minor side effects including localized swelling at the injection site, arthralgias, and low-grade fevers. Serious side effects are very rare. The risk of autoimmune phenomenon following flu vaccination is a debated topic.3 Multiple Evanescent White-Dot Syndrome is predominantly unilateral and is more commonly seen in young myopic women.4 Several small (100-200 micrometers) discrete white lesions are witnessed deep in the retina or situated at level of the retinal pigment epithelium. The lesions are concentrated in the posterior pole, primarily in the perifoveal region, while sparing the fovea. The lesions are characterized by early hyperfluorescence and late staining on fluorescein angiography. A granular appearance to the macula is also seen with irregularity of the internal limiting membrane reflex.   This case involves a 27 years old female patient who experienced multiple evanescent white dot syndrome (retinal exudates), confrontation visual field test revealed central loss in the right eye and full visual field in the left eye (central vision loss), anterior vitreous inflammation of oculus dextrus (OD) (iridocyclitis), retinal pigment epithelium (rpe) irregularities (retinal pigment epitheliopathy), central flashing lights in her right eye, photopsia of oculus dextrus (OD) (photopsia), nonpigmented deep retinal or chorioretinal lesions in the posterior pole (chorioretinal scar) and enlarged blind spot in the right eye (visual field defect), while she received vaccine INFLUENZA VACCINE.  The patient's medical history included Stevens-Johnson syndrome, Wolff-Parkinson-White syndrome, Vesicoureteric reflux, Endometriosis, fibroadenomas, Depression, Tonsillectomy and Vesicoureteral reflux surgery. The patient's past medical treatment included ATENOLOL with 25 milligram one a day and CENTRUM PLUS with one a day. The patient's past vaccination(s) and family history were not provided. At the time of the event, the patient had ongoing Chronic kidney disease, allergies to multiple antibiotics and Non-tobacco user.   On an unknown date, the patient received a dose of suspect INFLUENZA VACCINE produced by unknown manufacturer lot number not reported via intradermal route in unknown administration site.  On an unknown date, the patient developed a serious multiple evanescent white dot syndrome (retinal exudates), confrontation visual field test revealed central loss in the right eye and full visual field in the left eye (central vision loss), anterior vitreous inflammation of oculus dextrus (OD) (iridocyclitis) and retinal pigment epithelium (rpe) irregularities (retinal pigment epitheliopathy) (Unknown latency) following the administration of INFLUENZA VACCINE. These events was assessed as medically significant. On an unknown date, the patient developed a non-serious central flashing lights in her right eye, photopsia of oculus dextrus (OD) (photopsia), two weeks following the administration of INFLUENZA VACCINE. On an unknown date, the patient developed a non-serious nonpigmented deep retinal or chorioretinal lesions in the posterior pole (chorioretinal scar) and enlarged blind spot in the right eye (visual field defect) (Unknown latency) following the administration of INFLUENZA VACCINE.  Relevant laboratory test results included Fluorescence angiogram abnormal, Intraocular pressure test: 12 mmHg visual acuity tests : 20/25-2 OD unit and [20/20 OS] and visual field tests done on an unknown date.  (Other relevant tests included 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.  Fundus examination of the right eye revealed scattered non-pigmented deep retinal or chorioretinal lesions in the posterior pole. The optic nerve appeared normal.  Fluorescein Angiography of the right eye showed multiple round lesions in the posterior pole with early hyper-fluorescence and late staining  Fundus examination OS was normal. Humphrey visual field testing revealed an enlarged blind spot in the right eye. The macular lesions on exam had resolved with mild residual RPE mottling.  She did not report any symptoms from her left eye. And she did not drink. A comprehensive review of systems was negative for fever, rash, oral ulcers, arthralgias, headache, or vertigo. There was no history of recent viral illness. Pupillary reaction, motility, and adnexa exam were unremarkable. The optic nerve appeared normal. Fundus examination OS was normal.  Final diagnosis was retinal exudates, central vision loss, iridocyclitis, retinal pigment epitheliopathy, photopsia, chorioretinal scar and visual field defect.   No corrective treatment was received.  The patient was recovering from the events.  Vaccines work by exposing the immune system to specific pathogenic features that prime the immune response through adaptive immunity as well as cellular memory. Excessive lymphocyte activation, abnormal cytokine expression, and molecular mimicry are several possible mechanisms that could potentially play a role in the development of autoimmune phenomena following vaccination.  There will be no information available on the batch number for this case.; Sender's Comments: This case involves a 27 years old female patient who presented with retinal exudates, central vision loss, iridocyclitis, retinal pigment epitheliopathy, photopsia, chorioretinal scar and visual field defect after vaccination with INFLUENZA VACCINE. Time to onset is compatible for photopsia and unknown for other events. Patients medical condition at the time of vaccination was Stevens-Johnson syndrome, Wolff-Parkinson-White syndrome, Vesicoureteric reflux, Endometriosis, fibroadenomas, Depression, Tonsillectomy and Vesicoureteral reflux surgery and tests showed abnormal Fluorescence angiogram. Based upon the reported information, the role of the vaccine cannot be assessed.