Case study: Posterior Uveitis Post COVID-19 Vaccination

Case presentation: A 28-year-old Brazilian female patient presented to the emergency eye unit complaining about decreased vision in the oculus dexter (OD), i.e., right eye for 4 days. She took the first dose of COVID-19 vaccine and a day after that she started with fever, cough, shortness of breath, and runny nose. Two days after the vaccine shot, she noticed decreased vision. No trauma, no previous systemic conditions, or use of medications. On examination: Best Corrected Visual Acuity (BCVA): Right eye: Hand motion Left eye: 20/20 Intraocular pressure (IOP): Normal, 14 mmHg in both eyes Slit-lamp examination (SLE): Right eye was a quiet eye with a clear cornea, 2+ AC cells with pigments on the anterior lens capsule, and a clear lens. The left eye was completely normal. Fundus examination and photography: Relatively clear vitreous with marked optic disc edema and macular edema. Diffuse perivenular sheathing, blurry spot hemorrhages. A whitish retinal infiltrates inferiorly to the center of the fovea. Clear venular shaping with a frost branch aspect can be seen. Fundus autofluorescence: A geographic hypoautofluorescence in the posterior pole. Hypoautofluoroscent spots corresponding to retinal hemorrhages. Optical coherence tomography (OCT): Inflammatory exudation in the vitreoretinal interface. Retinal edema with a foveal serous detachment. Probable Diagnosis: Posterior uveitis after COVID-19 vaccination. Frosted branch angiitis with a perifoveal infiltrate. Association with the vaccine? Laboratory investigations: Diagnosis: Toxoplasmic retinitis associated with frosted branch angitic response. Treatment: Azithromycin 500 mg every other day. Pyrimethamine 50 mg per day and Folinic acid 7.5 mg per day. Follow-up: On day 7 of treatment, prednisone 60 mg per day was initiated and the whitish infiltrate got much more delineated and smaller and there was an improvement in her optic disc edema and in the peri-granular shaping. Her visual acuity got better. There was an improvement of the…

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