Threatened corneal graft rejection and ocular inflammation after SARS-CoV-2 infection and influenza vaccine

Abstract

Introduction: To report the case of an individual who developed autoinflammation after contracting Coronavirus Disease 2019 (COVID-19) and receiving an influenza vaccination. Case Report: A 61-year-old woman presented to us after two episodes of recurrent, acute, partial-thickness corneal graft rejection; the first of these began five months after Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and shortly after influenza vaccination. Best corrected visual acuity was 20/20 in both eyes, and anterior chambers showed no evidence of inflammation. Fluorescein angiogram revealed disc staining in both eyes, and B-scan showed chorioretinal thickening in the left eye. She was diagnosed with posterior scleritis of the left eye and started on naproxen 500 mg twice daily with acyclovir 400 mg daily. This treatment regimen allowed her pain to resolve. Serology showed evidence of systemic inflammation with elevated antinuclear antibodies (ANA), and ocular inflammation was controlled with systemic immunomodulatory therapy. Conclusion: Severe Acute Respiratory Syndrome Coronavirus 2 infection may induce a long-term, systemic autoinflammatory state that may be provoked by further immune challenges, such as influenza vaccination, resulting in ocular inflammation.