title: Acute Bilateral Photoreceptor Degeneration in an Infant After Vaccination Against Measles and Rubella.
abstract: Ocular inflammation is occasionally observed after vaccinations, and most of them resolve without permanent visual disturbances. However, there are some rare cases of severe ocular complications following vaccinations.
  
  
  
  To report the findings in an infant boy who developed an acute loss of vision bilaterally after Haemophilus influenzae type b, Pneumococcal conjugate vaccination, and measles and rubella vaccination. His vision did not recover.
  
  
  
  A retrospective review of the medical records of a 13-month-old Japanese boy.
  
  
  
  Fundus and fluorescein angiographic findings, ultrasonographic and optical coherence tomographic images, and electroretinographic findings.
  
  
  
  A healthy 13-month-old boy had an acute loss of vision in both eyes 31 days after Haemophilus influenzae type b and Pneumococcal conjugate vaccinations and 24 days after a measles and rubella vaccination. He also developed a common cold 10 days before the vision loss. Ultrasonography showed an exudative retinal detachment 1 day after the onset of the visual reduction; however, his fundi appeared normal 4 days later. His eyes did not pursue objects, and pupillary light reflexes were not present. No signs of anterior uveitis were noted. He was treated with corticosteroids, but his vision did not improve. The retinal vessels gradually attenuated, and diffuse small white punctate lesions appeared in the deep retina. Optical coherence tomography showed a thinner outer nuclear layer and an absent ellipsoid zone. The electroretinograms were nonrecordable. These findings suggested a severe impairment of the photoreceptors, especially their outer segments. Western blot analysis of the patient's sera detected an antibody against recoverin, a calcium-binding protein of photoreceptors.
  
  
  
  We hypothesize that an infection induced severe chorioretinitis with an exudative retinal detachment, which then produced an autoantibody against recoverin. The autoantibody then altered the function of the photoreceptors very rapidly. The initial infection may have been caused by the measles and rubella vaccination. However, because to our knowledge this has not been reported previously, the visual loss after the vaccinations may have been an extremely rare event that was coincidental or may have been related to the vaccination.
authors.affiliation: Department of Ophthalmology, Kindai University Faculty of Medicine, Osaka-Sayama City, Osaka, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Kuniyoshi
authors.affiliation: Department of Ophthalmology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Hatsukawa
authors.affiliation: Department of Pediatric Neurology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan.
authors.forename: Sadami
authors.initials: S
authors.lastname: Kimura
authors.affiliation: Department of Ophthalmology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Fujino
authors.affiliation: Department of Ophthalmology, Sapporo Medical University, Sapporo, Hokkaido, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ohguro
authors.affiliation: Department of Pediatric Neurology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan.
authors.forename: Rie
authors.initials: R
authors.lastname: Nakai
authors.affiliation: Department of Ophthalmology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan.
authors.forename: Kenta
authors.initials: K
authors.lastname: Sunami
authors.affiliation: Department of Ophthalmology, Seichokai Fuchu Hospital, Izumi, Japan.
authors.forename: So-Ichiro
authors.initials: SI
authors.lastname: Mishima
authors.affiliation: Department of Ophthalmology, Kindai University Faculty of Medicine, Osaka-Sayama City, Osaka, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Ophthalmology, Kindai University Sakai Hospital, Sakai, Osaka, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Kusaka
authors.affiliation: Department of Pediatric Neurology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Suzuki
authors.affiliation: Department of Ophthalmology, Kindai University Faculty of Medicine, Osaka-Sayama City, Osaka, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Shimomura
mesh_terms: D000208:Acute Disease; D004596:Electroretinography; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006801:Humans; D007223:Infant; D008297:Male; D008458:Measles Vaccine / Q000009:adverse effects*; D010786:Photoreceptor Cells / Q000473:pathology*; D012162:Retinal Degeneration / Q000175:diagnosis / Q000209:etiology*; D012411:Rubella Vaccine / Q000009:adverse effects*; D041623:Tomography, Optical Coherence / Q000379:methods; D014611:Vaccination / Q000009:adverse effects*
chemical_list: D008458:Measles Vaccine; D012411:Rubella Vaccine