key: cord-0803452-mrffmqzx authors: Pan, Lijie; Zhang, Yuting; Cui, Yan; Wu, Xinyi title: Bilateral uveitis after inoculation with COVID-19 vaccine: A case report date: 2021-09-30 journal: Int J Infect Dis DOI: 10.1016/j.ijid.2021.09.075 sha: a1a2070296d8ba47e3c1660bd2e8e491f3275205 doc_id: 803452 cord_uid: mrffmqzx Background Coronavirus disease 2019 (COVID-19) is a highly infectious and pathogenic respiratory disease. To date, there is no effective treatment, and there is an urgent need to develop vaccines against the virus. Five coronavirus COVID-19 vaccines have been approved for inoculation in China, with good safety and few adverse reactions. Case presentation A 50-year-old woman complained of bilateral blurred vision and visual distortion 5 days after vaccination with the inactivated COVID-19 vaccine. Physical and auxiliary examination showed that she developed bilateral posterior uveitis. The patient was administered local and systemic steroids, and the symptoms were appreciably improved 5 weeks later. Conclusions A case of bilateral uveitis after COVID-19 vaccination was reported and indicated that uveitis after vaccination appears transient and responds well to steroids. Coronavirus disease 2019 (COVID-19) is a highly infectious and pathogenic respiratory disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Shereen et al.,2020) . It has been declared a pandemic. According to Ocular complications after COVID-19 vaccination have been reported and include central serous retinopathy, acute abducens nerve palsy, and two cases of anterior uveitis (Fowler et al.,2021; Reyes-Capo et al.,2021; Renisi et al.,2021; El Sheikh et al.,2021) . One case of anterior uveitis occurred after BNT162b2 inoculation (Renisi et al.,2021) and the other after Sinopharm inoculation (El Sheikh et al.,2021) ; in both cases, the uveitis was resolved via use of topical steroids. Here, we report a case of bilateral posterior uveitis after inoculation with an inactivated COVID-19 vaccine. Given the high prevalence of COVID-19 and lack of specific, effective pharmaceutical treatments, the need for "herd immunity" is urgent. In China, five (Benage and Fraunfelder, 2016) . Patient age ranged widely from 2 months to 86 years, with a mean age of 30 years. The median duration from vaccination to the onset of uveitis was 16 days (range, 1 day to 6 years). Thirty-five cases were associated with simultaneous administration of two or more vaccines, and the most common uveitis-associated vaccines were the hepatitis B virus (40.5%), human papillomavirus (HPV) (15.6%), influenza virus (9.7%), Bacillus Calmette-Guérin (Stone, Brown,2017) . Delayed-type hypersensitivity, which involves CD4+ and CD8+ T-cells, is another important mechanism. In our case, although specific antibody test of the virus was not performed, the vaccination history of the patient, the duration of disease onset, the results of accessory examinations, and the good response to steroids strongly suggest that the uveitis was associated with the vaccine-induced immune response rather than an infection or systemic autoimmune diseases. The inactivated COVID-19 vaccine in our case was produced by infecting Vero cells with the SARS-CoV-2. After culturing the cells, the virus was harvested, inactivated, concentrated, purified, and absorbed to an adjuvant (aluminum hydroxide) to increase the immunogenicity of the virus. We speculate that the adjuvant caused the uveitis; a strong immune response occurred locally, resulting in damage to the uvea. In a randomized, double-blind phase II trial comprising 742 adults, the most common adverse reactions to an inactivated COVID-19 vaccine were slight pain, itching, redness at the injection site, and slight fatigue and fever; there were no serious events (Che, 2020) . The treatment of uveitis mainly consists of topical steroids, which is suitable for most patients with vaccine-related uveitis (Cunningham, Moorthy,2020) . For patients with severe or refractory uveitis, oral prednisone and immunosuppressive agents may be recommended. The remarkable recovery of our patient after periocular injection of triamcinolone acetonide and administration of oral steroids suggests that ocular inflammation after COVID-19 inoculation is mostly transient and responsive to glucocorticoids. Based on additional medical recommendations, we advised the patient to delay the second vaccination in case the immune response was reactivated. In conclusion, we reported a rare case of bilateral uveitis after inoculation with a COVID-19 vaccine. The prognosis of the patient suggests that uveitis after vaccination is probably transient and treatable. Ethics approval and consent to participate Approvals were given by the patient for reporting case details. Vaccine-Associated Uveitis Randomized, double-blinded and placebo-controlled phase II trial of an inactivated SARS-CoV-2 vaccine in healthy adults Vaccine-Associated Posterior Uveitis Acute Uveitis following COVID-19 Vaccination Vaccine-Associated Uveitis serous retinopathy after immunization with COVID-19 mRNA vaccine Live attenuated vaccines: historical successes and current challenges National Health Commission, PRC. Guidelines for Coronavirus-19 Vaccination Anterior uveitis onset after bnt162b2 vaccination: is this just a coincidence? Acute abducens nerve palsy following COVID-19 vaccination COVID-19 infection: Origin, transmission, and characteristics of human coronaviruses Angiotensin-converting Enzyme Inhibitor and Other Drug-associated Angioedema. Immunol Allergy Clin North Am Public Health Service (PHS), Centers for Disease Control (CDC) / Food and Drug Administration (FDA) World Health Organization. COVID-19 vaccine tracker and landscape We'd like to express our thanks to the patient and our colleagues. The authors declare that they have no competing interests. Not applicable. Lijie Pan collected the patient's data and images,and wrote the original manuscript.Yan Cui took part in the diagnosis and treatment of the patient. Yuting Zhang performed the FFA examination of the case. Xinyi Wu was responsible for revising the draft. All authors read and approved the final manuscript.