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Case Report
Threatened corneal graft rejection and ocular inflammation after SARS-CoV-2 infection and influenza vaccine
1 Massachusetts Eye Research and Surgery Institution, Waltham, MA, United States
2 The Ocular Immunology and Uveitis Foundation, Waltham, MA, United States
3 Harvard Medical School, Department of Ophthalmology, Boston, MA, United States
Address correspondence to:
Charles Stephen Foster
MD, FACR, FACS, Massachusetts Eye Research and Surgery Institution, 1440 Main St., Ste. 201, Waltham, MA,
USA
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Article ID: 100037Z17AD2023
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Dolinko AH, Maleki A, Foster CS. Threatened corneal graft rejection and ocular inflammation after SARS-CoV-2 infection and influenza vaccine. J Case Rep Images Opthalmol 2023;6(1):9–12.ABSTRACT
Introduction: To report the case of an individual who developed autoinflammation after contracting Coronavirus Disease 2019 (COVID-19) and receiving an influenza vaccination.
Case Report: A 61-year-old woman presented to us after two episodes of recurrent, acute, partial-thickness corneal graft rejection; the first of these began five months after Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and shortly after influenza vaccination. Best corrected visual acuity was 20/20 in both eyes, and anterior chambers showed no evidence of inflammation. Fluorescein angiogram revealed disc staining in both eyes, and B-scan showed chorioretinal thickening in the left eye. She was diagnosed with posterior scleritis of the left eye and started on naproxen 500 mg twice daily with acyclovir 400 mg daily. This treatment regimen allowed her pain to resolve. Serology showed evidence of systemic inflammation with elevated antinuclear antibodies (ANA), and ocular inflammation was controlled with systemic immunomodulatory therapy.
Conclusion: Severe Acute Respiratory Syndrome Coronavirus 2 infection may induce a long-term, systemic autoinflammatory state that may be provoked by further immune challenges, such as influenza vaccination, resulting in ocular inflammation.
Keywords: Cornea graft rejection, COVID-19, Influenza vaccination, Posterior scleritis, SARS-CoV-2
SUPPORTING INFORMATION
Acknowledgments
We thank the patient described herein for graciously allowing us to discuss her case. We also thank the MERSI technicians for their expertise in performing the imaging studies for this patient.
Author ContributionsAndrew H Dolinko - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Arash Maleki - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Charles Stephen Foster - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2023 Andrew H Dolinko et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
