A review of pathogenesis and diagnosis and treatment of vaccine-associated uveitis_Chinese Journal of Ocular Fundus Diseases

Authors：

Wu Shuo , Zhang Chuan , Zhao Mingwei ,  Hou Jing

Department of Ophthalmology, Peking University People's Hospital; Eye diseases and optometry institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing 100044, China;

Corresponding author：

Hou Jing, Email: drhoujing@163.com

Keywords：

Vaccine-associated uveitis; Epidemiology; Pathogenesis; Diagnosis and treatment; Review

DOI：

10.3760/cma.j.cn511434-20220126-00046

Video：

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Abstract Full text Figures/Tables Video References Cited by

Vaccine-associated uveitis (VAU) usually refers to a rare adverse reaction that occurs after vaccination. The clinical manifestations of VAU are most often anterior with mild symptoms and responded promptly to topical corticosteroids. However, more severe forms of posterior and panuveitis may also occur, such as multiple evanescent white dot syndrome, Vogt-Koyanagi-Harada syndrome, and acute posterior multifocal placoid pigment epitheliopathy. The pathogenesis of VAU is still unclear. Currently, it mainly includes vaccine Shoenfeld syndrome, type Ⅲ hypersensitivity reaction caused by immune complex deposition, direct infection with live attenuated vaccine, and molecular mimicry theory. VAU is self-limiting, and most patients heal without treatment. In the future, it is recommended to ask all patients with uveitis about their recent vaccination history in the clinic. For patients with inactivated vaccine or recombinant/subunit vaccination history, the possibility of developing Shoenfeld syndrome should be considered, and the history, signs and symptoms related to autoimmune diseases should be carefully looked for.

Citation： Wu Shuo, Zhang Chuan, Zhao Mingwei, Hou Jing. A review of pathogenesis and diagnosis and treatment of vaccine-associated uveitis. Chinese Journal of Ocular Fundus Diseases, 2023, 39(9): 773-778. doi: 10.3760/cma.j.cn511434-20220126-00046 Copy

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2.	Kuniyoshi K, Hatsukawa Y, Kimura S, et al. Acute bilateral photoreceptor degeneration in an infant after vaccination against measles and rubella[J]. JAMA Ophthalmol, 2017, 135(5): 478-482. DOI: 10.1001/jamaophthalmol.2017.0380.
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1. Roush SW, Murphy TV, Vaccine-Preventable Disease Table Working Group. Historical comparisons of morbidity and mortality for vaccine-preventable diseases in the United States[J]. JAMA, 2007, 298(18): 2155-2163. DOI: 10.1001/jama.298.18.2155.
2. Kuniyoshi K, Hatsukawa Y, Kimura S, et al. Acute bilateral photoreceptor degeneration in an infant after vaccination against measles and rubella[J]. JAMA Ophthalmol, 2017, 135(5): 478-482. DOI: 10.1001/jamaophthalmol.2017.0380.
3. Fraunfelder FW, Suhler EB, Fraunfelder FT. Hepatitis B vaccine and uveitis: an emerging hypothesis suggested by review of 32 case reports[J]. Cutan Ocul Toxicol, 2010, 29(1): 26-29. DOI: 10.3109/15569520903427717.
4. Holt HD, Hinkle DM, Falk NS, et al. Human papilloma virus vaccine associated uveitis[J]. Curr Drug Saf, 2014, 9(1): 65-68. DOI: 10.2174/15748863113086660062.
5. Cunningham ET Jr, Moorthy RS, Fraunfelder FW, et al. Vaccine-associated uveitis[J]. Ocul Immunol Inflamm, 2019, 27(4): 517-520. DOI: 10.1080/09273948.2019.1626188.
6. Cochrane CG, Koffler D. Immune complex disease in experimental animals and man[J]. Adv Immunol, 1973, 16(0): 185-264. DOI: 10.1016/s0065-2776(08)60298-9.
7. Watad A, Bragazzi NL, McGonagle D, et al. Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) demonstrates distinct autoimmune and autoinflammatory disease associations according to the adjuvant subtype: insights from an analysis of 500 cases[J]. Clin Immunol, 2019, 203: 1-8. DOI: 10.1016/j.clim.2019.03.007.
8. Watad A, Quaresma M, Bragazzi NL, et al. The autoimmune/inflammatory syndrome induced by adjuvants (ASIA)/shoenfeld's syndrome: descriptive analysis of 300 patients from the international ASIA syndrome registry[J]. Clin Rheumatol, 2018, 37(2): 483-493. DOI: 10.1007/s10067-017-3748-9.
9. Reed SG, Orr MT, Fox CB. Key roles of adjuvants in modern vaccines[J]. Nat Med, 2013, 19(12): 1597-1608. DOI: 10.1038/nm.3409.
10. Pasare C, Medzhitov R. Toll pathway-dependent blockade of CD4+CD25+ T cell-mediated suppression by dendritic cells[J]. Science, 2003, 299(5609): 1033-1036. DOI: 10.1126/science.1078231.
11. Khan Z, Combadière C, Authier FJ, et al. Slow CCL2-dependent translocation of biopersistent particles from muscle to brain[J/OL]. BMC Med, 2013, 11: 99[2013-04-04]. https://pubmed.ncbi.nlm.nih.gov/23557144/. DOI: 10.1186/1741-7015-11-99.
12. Shaw CA, Petrik MS. Aluminum hydroxide injections lead to motor deficits and motor neuron degeneration[J]. J Inorg Biochem, 2009, 103(11): 1555-1562. DOI: 10.1016/j.jinorgbio.2009.05.019.
13. Gherardi RK, Coquet M, Cherin P, et al. Macrophagic myofasciitis lesions assess long-term persistence of vaccine-derived aluminium hydroxide in muscle[J]. Brain, 2001, 24(Pt 9): 1821-1831. DOI: 10.1093/brain/124.9.1821.
14. Karussis D, Petrou P. The spectrum of post-vaccination inflammatory CNS demyelinating syndromes[J]. Autoimmun Rev, 2014, 13(3): 215-224. DOI: 10.1016/j.autrev.2013.10.003.
15. Cunningham ET Jr, Moorthy RS. Vaccine-associated posterior uveitis[J]. Retina, 2020, 40(4): 595-598. DOI: 10.1097/IAE.0000000000002816.
16. Ng XL, Betzler BK, Ng S, et al. The eye of the storm: covid-19 vaccination and the eye[J] Ophthalmol Ther, 2021, 11(1): 81-100. DOI: 10.1007/s40123-021-00415-5.
17. Kniker WT, Cochrane CG. The localization of circulating immune complexes in experimental serum sickness. The role of vasoactive amines and hydrodynamic forces[J]. J Exp Med, 1968, 127(1): 119-136. DOI: 10.1084/jem.127.1.119.
18. Hylkema HA, Kijlstra A. Circulating immune complexes in uveitis patients[J]. Int Ophthalmol, 1989, 13(4): 253-257. DOI: 10.1007/BF02280084.
19. Willis ED, Woodward M, Brown E, et al. Herpes zoster vaccine live: a 10 year review of post-marketing safety experience[J]. Vaccine, 2017, 35(52): 7231-7239. DOI: 10.1016/j.vaccine.2017.11.013.
20. Guex-Crosier Y, Chamot L, Zografos L. Chorioretinitis induced by intravesical bacillus calmette-guérin (BCG) instillations for urinary bladder carcinoma[J]. Klin Monbl Augenheilkd, 2003, 220(3): 193-195. DOI: 10.1055/s-2003-38179.
21. Llorenç V, Mesquida M, Molins B, et al. Bacillus calmette-guérin infection and cytotoxicity in the retinal pigment epithelium[J]. Ocul Immunol Inflamm, 2018, 26(5): 786-792. DOI: 10.1080/09273948.2016.1265655.
22. Cusick MF, Libbey JE, Fujinami RS. Molecular mimicry as a mechanism of autoimmune disease[J]. Clin Rev Allergy Immunol, 2012, 42(1): 102-111. DOI: 10.1007/s12016-011-8294-7.
23. Spratt A, Key T, Vivian AJ. Chronic anterior uveitis following bacille calmette-guérin vaccination: molecular mimicry in action?[J]. J Pediatr Ophthalmol Strabismus, 2008, 45(4): 252-253. DOI: 10.3928/01913913-20080701-15.
24. Garip A, Diedrichs-Möhring M, Thurau SR, et al. Uveitis in a patient treated with bacille-calmette-guérin: possible antigenic mimicry of mycobacterial and retinal antigens[J]. Ophthalmology, 2009, 116(12): 2457-62. DOI: 10.1016/j.ophtha.2009.05.021.
25. Furer V, Rondaan C, Heijstek MW, et al. 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases[J]. Ann Rheum Dis, 2020, 79(1): 39-52. DOI: 10.1136/annrheumdis-2019-215882.
26. Leibowitz JA, Woods AT, Kesselman MM, et al. Uveitis as a predictor of predisposition to autoimmunity[J/OL]. Cureus, 2020, 12(3): e7451[2020-03-28]. https://pubmed.ncbi.nlm.nih.gov/32351830/. DOI: 10.7759/cureus.7451.
27. Heydari-Kamjani M, Vante I, Uppal P, et al. Uveitis sarcoidosis presumably initiated after administration of shingrix vaccine[J/OL]. Cureus, 2019, 11(6): e4920[2019-06-17]. https://pubmed.ncbi.nlm.nih.gov/31423396/. DOI: 10.7759/cureus.4920.
28. Singal A, Sonthalia S, Pandhi D. Ulcerated lupus vulgaris at the site of bacille calmette-guérin vaccination[J]. Pediatr Dermatol, 2013, 30(1): 147-148. DOI: 10.1111/j.1525-1470.2011.01607.x.
29. Farsinejad K, Daneshpazhooh M, Sairafi H, et al. Lupus vulgaris at the site of BCG vaccination: report of three cases[J/OL]. Clin Exp Dermatol, 2009, 34(5): e167-e169[2008-12-15]. https://pubmed.ncbi.nlm.nih.gov/19094126/. DOI: 10.1111/j.1365-2230.2008.03041.x.
30. Cojocaru M, Cojocaru IM, Silosi I. Multiple autoimmune syndrome[J]. Maedica (Bucur), 2010, 5(2): 132-134.
31. London WT. Hepatitis B virus and antigen-antibody complex diseases[J]. N Engl J Med, 1977, 296(26): 1528-1529. DOI: 10.1056/NEJM197706302962613.
32. Moret Ch, Meier P, Rotman S, et al. Fever of unknown origin with granulomatous hepatitis, uveitis and acute renal failure[J]. Praxis (Bern 1994), 2005, 94(1-2): 25-30. DOI: 10.1024/0369-8394.94.1.25.
33. Farthing CF, Howard RS, Thin RN. Papillitis and hepatitis B[J/OL]. Br Med J (Clin Res Ed), 1986, 292(6537): 1712[1986-06-28]. https://pubmed.ncbi.nlm.nih.gov/3089367/. DOI: 10.1136/bmj.292.6537.1712.
34. Grob PJ, Martenet AC, Witmer R. Nonspecific immune parameters and hepatitis B antigens in patients with uveitis[J]. Mod Probl Ophthalmol, 1976, 16: 254-258.
35. Murray PI, Prasad J, Rahi AH. Status of hepatitis B virus in the aetiology of uveitis in great britain[J]. Br J Ophthalmol, 1983, 67(10): 685-687. DOI: 10.1136/bjo.67.10.685.
36. Benage M, Fraunfelder FW. Vaccine-associated uveitis[J]. Mo Med, 2016, 113(1): 48-52.
37. Fried M, Conen D, Conzelmann M, et al. Uveitis after hepatitis B vaccination[J]. Lancet, 1987, 2(8559): 631-632. DOI: 10.1016/s0140-6736(87)93027-3.
38. Ray CL, Dreizin IJ. Bilateral optic neuropathy associated with influenza vaccination[J]. J Neuroophthalmol, 1996, 16(3): 182-184.
39. Solomon A, Siganos CS, Frucht-Pery J. Adverse ocular effects following influenza vaccination[J]. Eye (Lond), 1999, 13(Pt 3a): 381-382. DOI: 10.1038/eye.1999.101.
40. Skowronski DM, Strauss B, De Serres G, et al. Oculo-respiratory syndrome: a new influenza vaccine-associated adverse event?[J]. Clin Infect Dis, 2003, 36(6): 705-713. DOI: 10.1086/367667.
41. Blumberg S, Bienfang D, Kantrowitz FG. A possible association between influenza vaccination and small-vessel vasculitis[J]. Arch Intern Med, 1980, 140(6): 847-848. DOI: 10.1001/archinte.1980.00330180121037.
42. Dogan B, Erol MK, Cengiz A. Vogt-koyanagi-harada disease following BCG vaccination and tuberculosis[J/OL]. Springerplus, 2016, 5: 603[2016-05-12]. https://pubmed.ncbi.nlm.nih.gov/27247899/. DOI: 10.1186/s40064-016-2223-4.
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