COVID-19 백신 접종 후 발생한 독성전방증후군 양상의 양안 안구염증 이상 반응 1예
A Toxic Anterior Segment Syndrome-like Ocular Inflammatory Reaction after COVID-19 Vaccination
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목적: COVID-19 백신 접종 후 수시간에 발생한 독성전방증후군 양상의 양안 안구염증 이상 반응 증례를 경험하여 이를 보고하고자한다. 증례요약: 두부 대상포진 과거력이 있는 70세 여자가 양안 백내장수술 직후 좋은 시력을 보였다고 하였으나, 수술 4일 후 Vaxzevria COVID-19 백신(Astrazeneca) 2차 접종을 받고, 두통을 동반한 갑작스러운 양안의 시력저하를 주소로 내원하였다. 내원 시 최대교정시력은 우안 0.2, 좌안 0.1이었다. 세극등현미경검사상 양안 각막부종, 전방 염증 반응, 인공수정체 광학부에 염증성 섬유막이 관찰되었다. 경구 및 점안 스테로이드 치료 7일 후 전방 염증 및 인공수정체 섬유막은 크게 호전되었다. 전방천자를 통한 방수 중합효소연쇄반응검사 결과 양안 모두에서 수두대상포진바이러스가 검출되었으며, 안구광학단층촬영에서 양안 낭포황반부종이 관찰되었다. 치료3달째 양안 교정시력은 우안 0.6, 좌안 0.4로 호전되었으나 낭포황반부종은 뚜렷한 호전을 보이지 않았다. 결론: 대상포진 과거력이 있는 환자에서 COVID-19 백신 접종 직후 수두대상포진바이러스와 관련된 안구염증 이상 반응이 생길 수있다.
Abstract
Purpose: We report a case with bilateral, ocular inflammatory adverse reactions developing a few hours after COVID-19 vaccination. Case summary: A 70-year-old woman complained of headache and sudden visual impairment (both eyes) a few hours after COVID-19 vaccination (Astrazeneca). She had undergone bilateral cataract surgery 4 days before vaccination and her eyesight was good immediately after surgery. The best-corrected visual acuities (BCVA) were 0.2 and 0.1 in the right and left eyes, respectively. Diffuse corneal edema, anterior chamber reactions, inflammatory fibrinoid membranes on the anterior surfaces of the intraocular lenses (IOLs), and cystoid macular edema were observed in both eyes. The anterior chamber and IOL fibrinoid reactions much improved 7 days after the prescription of topical and oral corticosteroids. The aqueous humor polymerase chain reaction was positive for varicella zoster virus (VZV) in both eyes. The BCVA improved to 20/30 in the right eye and 20/50 in the left eye after 3 months of additional treatment. However, the cystoid macular edema did not improve. Conclusions: In patients with a history of herpes zoster infection, adverse ocular inflammatory reactions associated with VZV may occur immediately after COVID-19 vaccination.
참고문헌 (15)
- Park CY, "Toxic anterior segment syndrome-an updated review", BMC Ophthalmol, 18, pp.276~ (2018)
- Mamalis N, "Toxic anterior segment syndrome", J Cataract Refract Surg, 32, pp.324~333 (2006)
- Maier P, "Toxic anterior segment syndrome following penetrating keratoplasty", Arch Ophthalmol, 126, pp.1677~1681 (2008)
- Cheng JY, "Ocular adverse events following vaccination : overview and update", Surv Ophthalmol, 67, pp.293~306 (2022)
- Ng XL, "Ocular adverse events after COVID-19 vaccination", Ocul Immunol Inflamm, 29, pp.1216~1224 (2021)
- Reyes-Capo DP, "Acute abducens nerve palsy following COVID-19 vaccination", J AAPOS, 25, pp.302~303 (2021)
- Fowler N, "Acute-onset central serous retinopathy after immunization with COVID-19 mRNA vaccine", Am J Ophthalmol Case Rep, 23, pp.101136~ (2021)
- Bøhler AD, "Acute macular neuroretinopathy following COVID-19 vaccination", Eye(Lond), 36, pp.644~645 (2022)
- Panovska-Stavridis I, "A rare case of superior ophthalmic vein thrombosis and thrombocytopenia following ChAdOx1 nCoV-19 vaccine against SARS-CoV-2", Mediterr J Hematol Infect Dis, 13, pp.e2021048~ (2021)
- Bayas A, "Bilateral superior ophthalmic vein thrombosis, ischaemic stroke, and immune thrombocytopenia after ChAdOx1 nCoV-19 vaccination", Lancet, 397, pp.e11~ (2021)
- Psichogiou M, "Reactivation of varicella zoster virus after vaccination for SARS-CoV-2", Vaccines(Basel), 9, pp.572~ (2021)
- Junli Zhou, "Zoster sine herpete: a review", The Korean Journal of Pain, 33(3), pp.208~215 (2020), 대한통증학회[DOI]
- 박형준, "눈대상포진환자에서 눈물 수두대상포진바이러스 중합효소연쇄반응검사의 유용성", 대한안과학회지, 61(4), pp.334~340 (2020), 대한안과학회
- Crooke SN, "Immunosenescence and human vaccine immune responses", Immun Ageing, 16, pp.25~ (2019)
- Milikan JC, "Identification of viral antigens recognized by ocular infiltrating T cells from patients with varicella zoster virus-induced uveitis", Invest Ophthalmol Vis Sci, 48, pp.3689~3697 (2007)