Multiple evanescent white dot syndrome after human papillomavirus vaccination.
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.
Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Ken
K
Ogino
Department of Ophthalmology, Gunma University School of Medicine, Maebashi, Japan.
Shoji
S
Kishi
Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Nagahisa
N
Yoshimura
Acute zonal occult outer retinopathy; Human papillomavirus; Multiple evanescent white dot syndrome; Vaccination