Multiple Evanescent White Dot Syndrome after Human Papillomavirus Vaccination

Publisher： Karger

E-ISSN： 1663-2699|5|1|38-43

ISSN： 1663-2699

Source： Case Reports in Ophthalmology, Vol.5, Iss.1, 2014-02, pp. : 38-43

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Abstract

Although the cause of multiple evanescent white dot syndrome (MEWDS) has not been elucidated, 2 reports have described cases of MEWDS after vaccination. A 16-year-old girl presented with throat pain, headache, and photopsia in the left eye 2 weeks after receiving a human papillomavirus (HPV) vaccination. The clinical examination revealed numerous white dots on the fundus, visual field loss, and abnormal electroretinography results, which are concordant with a diagnosis of MEWDS. Although the white dots on the fundus disappeared within a few months, her visual field continued to deteriorate progressively over 1.5 years of follow-up. Images obtained by fundus autofluorescence and optical coherence tomography revealed longitudinal changes consistent with the observed functional losses. Immunosuppressive therapy (betamethasone 200 mg/day) resulted in the complete resolution of all fluorescein leakage from the retinal vasculature. Maintenance betamethasone treatment (0.5 mg/day) led to visual field results over a period of 6 months. In this case of MEWDS, subsequent to HPV vaccination, the results of fluorescein angiography showed a marked response to immunosuppressive therapy. These findings support the hypothesis that MEWDS is associated with an impaired immune function.