Silent progressive bilateral papillitis after COVID-19 vaccination: A case report

Abstract

Rationale: We report the case of a patient who developed asymptomatic bilateral papillitis after coronavirus disease 2019 (COVID-19) vaccination. Patient concerns: A 61-year-old man presented to our tertiary clinic with bilateral optic disc edema, which was incidentally detected during his visit to a primary ophthalmology clinic. He had received an adenovirus-vectored COVID-19 vaccine 2 weeks before the optic disc edema was detected and had experienced no ocular discomfort, except for a floater in his right eye. Although his visual acuity was normal and he had no color vision deficiencies or marked visual field defects, the optic disc edema worsened over several days. Orbital magnetic resonance imaging showed no optic tract enhancement, and lumbar puncture revealed normal cerebrospinal fluid pressure. The patient tested negative for aquaporin-4 and myelin oligodendrocyte glycoprotein antibodies and Leber hereditary optic neuropathy-associated gene mutations. Diagnosis: The patient was diagnosed with bilateral papillitis, possibly induced by the COVID-19 vaccination. Interventions: The patient received steroid pulse therapy with methylprednisolone (500 mg/day) for 3 days followed by an oral prednisolone taper for 3 weeks. Outcomes: The patient’s papillitis started to subside 3 weeks after he received systemic steroid therapy and completely resolved without any sequelae 2 months later. A year after the diagnosis, the fundus remained stable without disease recurrence or optic disc atrophy. Lessons: Healthy individuals receiving COVID-19 vaccines may present with various manifestations of optic neuritis. In the present case, the patient presented with asymptomatic progressive bilateral optic disc edema and had a favorable long-term course after receiving steroid therapy.

Systematic review exploring the clinical features of optic neuritis after SARS-CoV infection and vaccination

“…The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) flow chart is shown in figure 1. There were 34 studies of ON following COVID-19 infection,12–45 and an equal number of publications reported patients with ON post-COVID-19 vaccination 46–78. There were 19 case series and the remaining 49 were case reports.…”

Neurological Disorders following COVID-19 Vaccination

“…Cases of ON have been reported following various vaccines, including inactivated vaccines, adenoviral vector-based vaccines, and mRNA vaccines [ 84 , 85 , 86 ]. Both the first and second doses of vaccine-related ON have been reported, with an interval time of 0~19 days [ 85 , 87 , 88 ]. One or both sides of the optic nerve will be affected, typically presenting with visual impairment and eye pain, rarely presenting only papilledema [ 87 , 88 ].…”

“…Both the first and second doses of vaccine-related ON have been reported, with an interval time of 0~19 days [ 85 , 87 , 88 ]. One or both sides of the optic nerve will be affected, typically presenting with visual impairment and eye pain, rarely presenting only papilledema [ 87 , 88 ]. Myelin oligodendrocyte glycoprotein (MOG) IgG is present in some patients [ 85 ].…”