Sex: F
Vaccine: VARZOS
Symptoms: Angiotensin converting enzyme increased, Blood 1,25-dihydroxycholecalciferol increased, Calcium ionised increased, Chest X-ray abnormal, Chronic obstructive pulmonary disease
Clinical narrative: Uveitis sarcoidosis; Uveitis sarcoidosis; Headache; left eye redness; Photophobia; Eye pain; chronic obstructive pulmonary disease; mediastinal adenopathy; bilateral hilar; granulomatous disease; This case was reported in a literature article and described the occurrence of uveitis in a 53-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis.   The patient's past medical history included asthma (managed with inhaled Beta-2-agonist), swelling of knees and ankle swelling.   On an unknown date, the patient received Shingrix at an unknown dose. On an unknown date, 4 days after receiving Shingrix, the patient experienced uveitis (serious criteria GSK medically significant), sarcoidosis (serious criteria GSK medically significant), headache, eye red, photophobia, eye pain, chronic obstructive pulmonary disease, lymphadenopathy mediastinal, hilar lymphadenopathy and granulomatous disease. The patient was treated with corticosteroid nos (Corticosteroid (Trade Name Unknown)) and prednisone acetate. On an unknown date, the outcome of the uveitis, sarcoidosis, chronic obstructive pulmonary disease, lymphadenopathy mediastinal, hilar lymphadenopathy and granulomatous disease were unknown and the outcome of the headache, eye red, photophobia and eye pain were recovered/resolved.   The reporter considered the uveitis, sarcoidosis, headache, eye red, photophobia, eye pain, lymphadenopathy mediastinal, hilar lymphadenopathy and granulomatous disease to be possibly related to Shingrix. It was unknown if the reporter considered the chronic obstructive pulmonary disease to be related to Shingrix.  Additional details were reported as follows: This case was reported in a literature article and described the occurrence of uveitis sarcoidosis in a 53-years-old female who was vaccinated with Shingrix (GlaxoSmithKline) for prophylaxis. The patient was a woman. The patient was healthy. The patient's past medical history was significant only for mild persistent asthma managed with inhaled Beta-2-agonist. The patient reported a history of knee and ankle swelling which she attributed to walking and running. No information on patient's family history was provided. On an unspecified date, the patient received Shingrix vaccine (administration route and site unspecified, dosage unknown; batch number not provided). The age of vaccination is not provided but it could be 52 years or 53 years. On an unspecified date, 4 days after vaccination, the patient experienced eye complaints and presented to her primary care physician with complaints of headaches, left eye redness, photophobia, and eye pain. Afterwards, the patient was referred to rheumatology, where she was considered asymptomatic and thus, no systemic corticosteroid was indicated. Later, the patient was referred to ophthalmology. She was managed with ophthalmic corticosteroids that resulted in the resolution of her symptoms, but this ophthalmology consult was non-diagnostic as to etiology. Subsequently, her symptoms recurred a second time in the right eye. Physical examination did not reveal any joint, skin, pulmonary or cardiac findings to suggest an underlying connective tissue etiology.  The patient denied recent fever, rash, or tick bite. Laboratory results showed elevated levels of 1,25-hydroxy(OH)-Vitamin-D levels at 83 pg/mL, angiotensinogen converting enzyme (ACE) at 86 U/L, and calcium ions at 10.7 mg/dL (normal range not reported for all) and a positive rheumatoid factor (RF). Initial radiographic series suggested chronic obstructive pulmonary disease. Subsequent high-resolution computed tomography (HRCT) identified the presence of bilateral hilar and mediastinal adenopathy. The patient declined hilar biopsy which limited a definitive diagnosis of sarcoidosis. However, overall assessment based on the presence of uveitis, elevated laboratory values, and bilateral hilar and mediastinal adenopathy on HRCT, was suggestive of dormant granulomatous disease, presumably sarcoidosis. The patient was diagnosed with uveitis sarcoidosis.  The patient was treated with prednisone acetate eye drops which resulted in resolution of her uveitis. Repeat ACE level after resolution of uveitis was normal. The patient was currently being treated with ophthalmic corticosteroid medication.  On an unspecified date, the patient received 2nd dose of Shingrix with no further reoccurrence of uveitis. The suppression of uveitis could be explained by her current ophthalmic corticosteroid medication. The patient would continue to be tapered off ophthalmic corticosteroids. If there would be a reoccurrence of uveitis, a biologic therapy, such as adalimumab might be considered.  The authors stated "Overall, the presence of uveitis, elevated laboratory values, and bilateral hilar and mediastinal adenopathy on HRCT are suggestive of dormant granulomatous disease, presumably sarcoidosis that was possibly set off by the administration of the Shingrix vaccine. As a result, at this point, we cannot exclude the likelihood of the Shingrix vaccine as a trigger of uveitis-induced sarcoidosis in this patient." This article is not available for regulatory submission due to copyright restriction.      Lab Comments: Lab test done on unknown date. Physical examination did not reveal any joint, skin, pulmonary or cardiac findings to suggest an underlying connective tissue etiology.  High-resolution computed tomography (HRCT) identified the presence of bilateral hilar and mediastinal adenopathy.