Susac Syndrome Following COVID-19 Vaccination: A Case Report

Abstract

Due to the COVID-19 pandemic, numerous vaccines have been developed for the disease. However, with large-scale vaccination has come the gradual emergence of immunological phenomena caused by these new vaccines. Herein, we report a 48-year-old female with a sudden onset of inferior visual field defects in the left eye following her first dose of the ChAdOx1 vaccine. Dilated fundus examination combined with optical coherence tomography and fluorescein angiography confirmed the diagnosis of branch retinal artery occlusion. Within 4 weeks following vaccination, symptoms associated with hearing impairment developed, and magnetic resonance imaging revealed leptomeningeal enhancement. The diagnosis of Susac syndrome (SS) was confirmed. The development of SS may be caused by endotheliopathy resulting from the molecular mimicry of the ChAdOx1 vaccine. Clinicians should be aware of the symptoms of SS, which may develop after COVID-19 vaccination. Further experimental surveillance and case–control studies are required to confirm this relationship.

New onset of Susac syndrome after mRNA COVID-19 vaccine: a case report

“…Our case and similar reports [ 4 ] suggest a possible interaction between genetic background and environmental triggers leading to microvessel damage [ 3 ]…”

“…Onset of symptoms in our patient correlates with vaccine administration, but causality cannot be proven. Reports of other immune-mediated diseases developing as early as 2 days after the first dose of a COVID-19 vaccine [ 4 ] support the likelihood of SuS provoked by vaccination. In our case, the time interval between vaccination and symptoms onset was 4 days.…”

“…The COVID-19 pandemic has affected over 260 million people and different neurological disorders have been related to both Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and vaccination [ 3 ]. Six cases of SuS related to SARS-CoV-2 infection or vaccination have been described: two following SARS-CoV2 infection, one related to ChAdOx1 vaccine, and three after Coronavac vaccine [ 4 ]. Here we report the first case of SuS after BNT162b2 mRNA COVID-19 vaccine (Comirnaty®).…”

Retinal artery/vein occlusion complicating SARS-CoV-2 vaccinations

“…Matching with this consideration, several other cases of vaccine-related occlusion of the central retinal artery/vein have been reported after the 10 th January 2022. Chen et al reported a 48yo female who developed sudden onset of inferior visual field defects in the left eye four weeks following the first dose of the ChAdOx1 (Astra Zeneca) vaccine (AZV) 2 . Romano et al reported a 54yo female who developed central retinal vein occlusion 2 days after the second dose of the AZV 3 .…”

“…No mention is made of Susac syndrome characterised by retinal vascular occlusions, cerebral micro-angiopathy and hypoacusis. Susac syndrome has not only been reported in association with SARS-CoV-2 vaccinations 2 but also in a patient after smallpox vaccination 24 .…”