Título / Title

OPTIC NEURITIS AND RETINAL VASCULITIS AFTER YELLOW FEVER VACCINE: A CASE REPORT

Introdução / Purpose

Serious vaccine reactions, although rare, have been highlighted with the increase in vaccination against endemic diseases, such as yellow fever vaccine(YFV). Immunizers that contain attenuated agents can trigger or reactivate autoimmune mechanisms and lead to systemic and demyelinating diseases, including optic neuritis and retinal vasculitis. There is a recent description of diffuse retinal vasculitis associated with optic neuritis two weeks after YFV, as well as two other cases of neuromyelitis optica, in which the diagnosis was established based on the temporal relationship between vaccination and the onset of symptoms.

Material e Método / Methods

This report describes a young patient that presented with optic neurits, mielitis and retinal vasculitis after YFV.

Resultados / Results

14 years-old, female, presented with spastic paraplegia, a tingling sensation and decreased sensitivity in the lower limbs, with the diagnosis of transverse myelitis, 22 days after the YFV, when had fever for 2 days. After 1 month, referred low visual acuity (VA) in left eye (OS), eye movement pain, diagnosed with optic neuritis. On the exam presented with VA on the right eye 20/25 (OD) and 20/30 (OS). At slit lamp: anterior vitreous opacity in both eyes. Fundus examination:blurred optic nerve, perivascular sheathing. Anti aquaporin-4 negative, anti myelin oligodendrocyte glycoprotein negative. Negative screening for infectious and rheumatologic diseases. MRI of brain showed T2 hypersignal foci in the white substance, with perivascular enhancement. Spinal MRI with T2 slight change in signal. She received pulsetherapy with methylprednisolone 1g/day for 3 days, with improvement of brain and ocular injuries.

Discussão e Conclusões / Conclusion

Despite the difficulty in establishing a direct relationship between vaccination and the clinical picture presented, we consider that the YFV is a plausible etiology for the systemic and ocular repercussions presented, considering the temporal relationship between the onset of symptoms and the administration of the immunizing agent.

Palavras Chave

yellow fever; vaccination; vasculitis; optic neuritis

Area

CLINICAL RETINA