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Título

Vogt-Koyanagi-Harada syndrome after SARS-COV 2 vaccine: Case report

RESUMO

Case Summary: A 29-year-old female patient, who was vaccinated against SARS-COV-2 (Pfizer), sought a neurological emergency service 24 days after vaccination due to a severe, progressive headache, mainly in the right temporal region, with subsequent bilateral involvement associated with phonophobia, photophobia, nausea and dizziness. She also reported visual scotomas, tearing of the eyes and intense bilateral conjunctival hyperemia, with the development of blurred vision and diplopia. She was hospitalized and in the initial neurological evaluation showed a reduction in bilateral visual acuity, not accompanied by changes in extrinsic ocular muscles or direct pupillary changes. Other focal deficits were also not detected. She underwent imaging studies of the skull and initial orbits, which showed no changes. She also underwent lumbar puncture, which showed lymphomonocytic pleocytosis, with manometry within the normal range. An ophthalmologic evaluation was performed, which showed bilateral conjunctival hyperemia with ciliary injection and posterior synechiae of almost 360 degrees. The funcoscopy examination revealed cloudy media, pink papilla with clear edges, sensorineural retinal detachment in the macular region, presence of nodules in the middle periphery. papillitis, with Vogt-Koyanagi-Harada syndrome as the main suspect.

Discussion: Vogt-Koyanagi-Harada syndrome (VKH) is an inflammatory and autoimmune condition characterized by panuveitis, serous retinal detachment and extraocular manifestations (auditory, integumentary and central nervous system). Its autoimmunity mechanism may be associated with viral infections as well as vaccines. In the current scenario of mass vaccination due to the SARS-CoV2 pandemic, this association has also been evidenced, but with mechanisms still poorly described. The diagnosis of VKH is essentially clinical and can be confirmed with imaging tests. Treatment consists of the use of immunosuppressants, preferably started early to avoid the emergence of complications, mainly neuro-ophthalmological.

Conclusion: In the context of a pandemic and in the course of a global mass vaccination campaign, it is important to recognize possible complications associated with vaccination against COVID-19. However, to date, these risks are low and the benefits of vaccination outweigh any side effects.

Palavras Chave

Uveo-meningeal syndromes; Aseptic meningitis; Vaccines; SARS-CoV-2