Age: 34.0
Sex: M
Vaccine: FLUC4
Symptoms: Visual acuity tests abnormal, Visual field defect
Clinical narrative: Multiple evanescent white dot syndrome (MEWDS); This is a literature case, initially received on 24-Aug-2020, concerning a 34-year-old, male patient.   The aim of this study was to describe the multimodal imaging (MMI) findings and clinical course of a case of Multiple Evanescent White Dot Syndrome (MEWDS) following immunization with inactivated intra-dermal influenza virus, and to explore whether similarities exist with other, previously reported cases.  The patient's medical history included prior myopic-photorefractive keratectomy. Past ophthalmic, medical and surgical histories were otherwise unremarkable. It was reported that the patient was healthy.  On an unknown date, the patient was administered Flucelvax Quadrivalent [influenza vaccine, subunit influenza virus vaccine polyvalent, dose, route of administration, anatomical location, batch number and expiry date: not reported] for unreported indication.  On an unknown date, two weeks after vaccine administration, the patient developed para-central scotomata, grey haze, central photopsias and dyschromatopsia in his right eye. The patient denied any preceding viral symptoms.  Two weeks later, the patient was examined. The patient underwent snellen visual acuity and it was 20/20+2 on the right and 20/ 13-1 on the left. Intraocular pressure was 18 mmHg on the right and 14 mmHg on the left. Pupils, extraocular motility, and confrontation visual fields were unremarkable. Anterior segment examination was normal. Examination of the right-sided posterior segment was notable for mild foveal granularity and small, grey, outer-retinal lesions centered around the optic nerve with extension to the mid-periphery. The posterior segment of the left eye was unremarkable. At the locations of the grey retinal lesions, spectral domain-optical coherence tomography (SD-OCT) showed focal areas photoreceptor disruption; fundus autofluorescence revealed hyper-autofluorescence; indocyanine green angiography showed late hypofluorescence, and fluorescein angiography revealed multiple punctate areas of staining organized in a well-recognized wreath-like pattern. Collectively, these clinical and MMI findings lead to the diagnosis of MEWDS.  On an unknown date, at four-week follow-up, the symptoms and ophthalmologic findings resolved spontaneously without intervention. Best-corrected Snellen visual acuity improved to 20/16-1 in the right eye at this last visit.  It was concluded that this was the first reported case of MMI of post-influenza vaccination-associated MEWDS. Comparison with eight previously reported cases of MEWDS following immunization revealed that subjects tended to be healthy, young to middle age women with a median time to onset of two weeks. Vision tended to recover spontaneously over one to three months.  The event of MEWDS was considered serious due to the criterion of medical significance, per company.  The reporter assessed the event of MEWDS as related to Flucelvax Quadrivalent.  This case is linked to case 201904836 (in this article reference for 201904836 was provided).  Company comment: A 34-year-old, male patient was administered Flucelvax Quadrivalent vaccine. On an unknown date, two weeks after vaccine administration, the patient started to develop para-central scotomata, grey haze, central photopsias and dyschromatopsia in his right eye. Two weeks later, the patient was examined. Clinical and multimodal imaging (MMI) findings lead to the diagnosis of multiple evanescent white dot syndrome (MEWDS). The patient was enrolled in study aimed to describe the MMI findings and clinical course of a case of MEWDS following immunization with inactivated intra-dermal influenza virus. Aside from prior myopic-photorefractive keratectomy, it was reported that the patient was healthy. Since MEWDS is an uncommon inflammatory condition with currently unknown aetiology, causal role of the suspect vaccine cannot be excluded and is assessed as possibly related.; Sender's Comments: A 34-year-old, male patient was administered Flucelvax Quadrivalent vaccine. On an unknown date, two weeks after vaccine administration, the patient started to develop para-central scotomata, grey haze, central photopsias and dyschromatopsia in his right eye. Two weeks later, the patient was examined. Clinical and multimodal imaging (MMI) findings lead to the diagnosis of multiple evanescent white dot syndrome (MEWDS). The patient was enrolled in study aimed to describe the MMI findings and clinical course of a case of MEWDS following immunization with inactivated intra-dermal influenza virus. Aside from prior myopic-photorefractive keratectomy, it was reported that the patient was healthy. Since MEWDS is an uncommon inflammatory condition with currently unknown aetiology, causal role of the suspect vaccine cannot be excluded and is assessed as possibly related.