A Case of Acute Posterior Multifocal Placoid Pigment Epitheliopathy Following Human Papilloma Virus Vaccination

Jae Hyuck Lee; Hyun Tae Kim; Jeong Hun Bae

doi:10.3341/jkos.2017.58.3.358

Journal List > J Korean Ophthalmol Soc > v.58(3) > 1010731

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Lee, Kim, and Bae: A Case of Acute Posterior Multifocal Placoid Pigment Epitheliopathy Following Human Papilloma Virus Vaccination

Original Article

J Korean Ophthalmol Soc 2017;58(3):358-362.

Published online: 7 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.3.358

A Case of Acute Posterior Multifocal Placoid Pigment Epitheliopathy Following Human Papilloma Virus Vaccination

Jae Hyuck Lee, MD, Hyun Tae Kim, MD, Jeong Hun Bae, MD, PhD

Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

Address reprint requests to Jeong Hun Bae, MD, PhD Department of Ophthalmology, Kangbuk Samsung Hospital,#29 Saemunan-ro, Jongno-gu, Seoul 03181, Korea Tel: 82-2-2001-2250, Fax: 82-2-2001-2262 E-mail: jhbae94@hotmail.com

Received 10 November 201627 December 2016 Accepted 17 February 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) that developed after human papilloma virus (HPV) vaccination.

Case summary

A 31-year-old woman experienced sudden bilateral blurred vision and paracentral scotomas four days before visiting the hospital. The symptoms occurred two weeks after the second vaccination with quadrivalent HPV vaccine (Gardasil^®, MSD Korea, Seoul, Korea), and she had no pain or cold symptoms. At initial visit, the anterior chamber cells were observed, and the anterior vitreous was found to be clear. On fundus examination, multiple placoid yellow-whitish lesions were observed at the posterior pole, and fluorescein angiography showed early hypofluorescence and late hyperfluorescence with staining. Under a diagnosis of bilateral APMPPE, oral corticosteroid was used as treatment for two weeks, after which symptoms were resolved, anterior chamber cells disappeared, and lesions at the posterior pole markedly decreased. After five weeks, multiple hyper-reflective areas on the outer retinal layers as well as missing photoreceptor and retinal pigment epithelial layers were almost re-covered upon optical coherence tomography.

Conclusions

Non-infectious uveitis such as APMPPE can rarely present after HPV vaccination. Further studies are necessary to understand whether HPV vaccine is a direct cause of uveitis. J Korean Ophthalmol Soc 2017;58(3):358-362

Keywords: Acute posterior multifocal placoid pigment epitheliopathy, Human papilloma virus, Vaccination

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Figure 1.

Fundus photographs, optical coherence tomography and fluorescein angiography at the first visit. Multiple yellow-white pla-coid lesions scattered throughout the posterior pole in the right (A) and left (B) eyes are shown. Hyperreflections and disruptions on the retinal pigment epithelium and inner/outer segment junction corresponding to areas of yellow-white lesions in the right (C) and left (D) eyes are revealed. Early hypofluorescence of the lesions in the right (E) and left (F) eyes is noted while late hyperfluorescence with leak-age of the lesions is seen in the right (G) and left (H) eyes.

Figure 2.

Fundus photographs and optical coherence tomography after 5 weeks. Mild pigmentary change is observed on the macula of the right eye (A), and multiple placoid lesions disappear (B). The disruptions of the retinal pigment epithelium and inner/outer segment junction are partially recovered in the right (C) and left (D) eyes.

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