Acute posterior multifocal placoid pigment epitheliopathy after hepatitis B vaccine.
OBJECTIVE
To report two cases of acute posterior multifocal placoid pigment epitheliopathy after immunization with a recombinant hepatitis B virus vaccine.


METHODS
Case reports.


RESULTS
Two patients had development of visual loss 3 days to 2 weeks after the booster administration of 20 micrograms of recombinant hepatitis B virus surface antigen (Engerix-B). In both cases, fundus examination, fluorescein angiograms, and the course of the disease were typical of acute posterior multifocal placoid pigment epitheliopathy. In case 1, 1 week after immunization, the leukocyte count was 10.3 X 10(9)/L with 24% polynuclear eosinophils (2.47 X 10(9)/L); in case 2, blood cell counts were normal.


CONCLUSIONS
Hepatitis B virus immunization may be a risk factor for acute posterior multifocal placoid pigment epitheliopathy. Molecular mimicry between a retinal pigment epithelium protein and hepatitis B surface antigen could play a role. These cases suggest an immune-mediated retinal pigment epithelium disruption or choroidal vascular occlusions triggered by hepatitis B surface antigen.
Brézin
A P
AP
Hôpital Pitié-Salpêtrière, Paris, France.
Massin-Korobelnik
P
P
Boudin
M
M
Gaudric
A
A
LeHoang
P
P
D000208:Acute Disease; D000328:Adult; D004804:Eosinophils / Q000473:pathology; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006509:Hepatitis B / Q000517:prevention & control; D006514:Hepatitis B Surface Antigens / Q000276:immunology; D017325:Hepatitis B Vaccines / Q000009:adverse effects*; D006801:Humans; D007117:Immunization, Secondary; D007958:Leukocyte Count; D008297:Male; D010857:Pigment Epithelium of Eye / Q000473:pathology*; D012164:Retinal Diseases / Q000209:etiology*; D014614:Vaccines, Synthetic / Q000009:adverse effects*; D014786:Vision Disorders / Q000209:etiology; D014792:Visual Acuity
D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D014614:Vaccines, Synthetic