Resolution of Harada disease-like uveitis after quadrivalent human papillomavirus vaccination: a case report

Abstract

This article describes a patient who developed Harada disease-like uveitis after quadrivalent human papillomavirus (HPV4) vaccination and experienced resolution without any systemic treatment. To achieve this aim, a case report and a review of related literature on HPV vaccination causing uveitis were conducted. The results of this study show a diagnosis of Harada disease-like uveitis after HPV4 vaccination based on the vaccination history, clinical symptoms, and multimodal imaging. Resolution without any systemic corticosteroid treatment was observed. According to these findings, patients may develop uveitis with Harada-like features, which can be a mild and self-limiting process, after HPV4 vaccination.

Ocular Inflammation Post-Vaccination

“…Except for one unreported case [35], approximately 42.9% (three out of seven) of patients exhibited systemic symptoms such as fever, hearing loss, sore throat, headache, and joint pain [33][34][35]. With an average follow-up period of 1.2 years, vision completely recovered in five patients following corticosteroid treatment [21][22][23]34,35], including one patient who recovered with eyedrops alone [21]. However, some patients experience prolonged effects, such as recurrent leakage [33] (Figure 1) and extensive macular scarring [32].…”

“…After conducting a comprehensive review, a total of 51 reported cases (involving 61 patients), spanning from 1978 to 2023, have been associated with uveitis following various vaccinations (Table 1), including 4 case reports (5 patients) related to hepatitis B virus (HBV) vaccination [28][29][30][31]; 7 case reports (8 patients) related to human papillomavirus (HPV) vaccination [21][22][23][32][33][34][35]; 16 cases (18 patients) regarding uveitis after influenza vaccination [36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]; 3 cases (4 patients) related to measles-mumps-rubella (MMR) vaccination [52][53][54]; 12 cases (16 patients) related to varicella zoster virus (VZV) vaccination [24][25][26][27][55][56][57][58][59][60][61][62]; 4 cases (5 patients) for yellow fever [63][64]…”

“…The average age of the affected individuals was 38.5 years (range, 1-86 years), with a female predominance (female:male = 35:26). Based on the site of infection, this study included 11 cases of anterior uveitis [27,35,37,45,52,54,56,58,63], 1 case of intermediate uveitis [63], 8 cases of posterior uveitis [21,22,27,28,32,42], 3 cases of uveitis involving both anterior and intermediate segments [27,55,64], 1 case of anterior and posterior uveitis [38], and 7 cases of pan-uveitis [23,34,40,43,48,53]. Distinct types of uveitis, such as acute posterior multifocal placoid pigment epitheliopathy (APMPPE) [36,41,46,47,57], Vogt-Koyanagi-Harada syndrome (VKH) [31,39,49,51,65,66], multiple evanescent white dot syndrome (MEWDS) [30,33,50,[67][68][69][70], acute retinal necrosis (ARN) [24]…”

“…Our study specifically focused on uveitis and compiled the reported cases of HPV-related uveitis to date (Table 1). Seven cases involving eight female patients (average age = 21.75 years) [21][22][23][32][33][34][35] developed uveitis at various locations following HPV vaccination (two anterior [35], one posterior [32], two pan-uveitis [23,34], one MEWDS [33], and two Harada-like uveitis [21,22]). Symptoms manifested within weeks, ranging from 4 days to 10 weeks after vaccination, with the majority (four out of eight) occurring after the third vaccine dose [21,22,34,35].…”

“…Seven cases involving eight female patients (average age = 21.75 years) [21][22][23][32][33][34][35] developed uveitis at various locations following HPV vaccination (two anterior [35], one posterior [32], two pan-uveitis [23,34], one MEWDS [33], and two Harada-like uveitis [21,22]). Symptoms manifested within weeks, ranging from 4 days to 10 weeks after vaccination, with the majority (four out of eight) occurring after the third vaccine dose [21,22,34,35]. Except for one unreported case [35], approximately 42.9% (three out of seven) of patients exhibited systemic symptoms such as fever, hearing loss, sore throat, headache, and joint pain [33][34][35].…”