AofA Science Summary: Reversible blindness in bilateral optic neuritis associated with nasal flu vaccine.
Various case reports have shown possible associations between optic neuritis and different vaccines. Some of the vaccines include influenza, hepatitis B and anthraxPURPOSE:
To present evidence for a causal relationship between optic neuritis and Live Attenuated Influenza Vaccine (LAIV), administered as nasal flu vaccine.METHODS:
Case Report. In a 13-year-old male with bilateral optic neuritis, detailed clinical history, neuro-ophthalmologic examination, magnetic resonance imaging, stereo-disc photos, visual field testing, ocular coherence tomography, blood tests and cerebral spinal fluid analysis were performed.RESULTS:
Exam findings on presentation: BCVA: 20/CF OD; 20/LP OS. Positive relative afferent pupil defect OD. Unremarkable anterior segment and posterior segment exam. No papillitis or papilledema. Global visual field defect OU based on Humphrey 30-2. MRI: diffuse enlargement of Optic Chiasm with inflammation of distal optic nerves bilateral. Blood cultures and CSF were negative. Patient received 3 divided doses of methyl prednisone with mild improvement of vision upon hospital discharge and marked improvement of vision at 2 month follow up.CONCLUSION:
In this child, no infectious, vascular, granulomatous, viral or immune-related cause of optic neuritis was identified. This case provides compelling evidence that supports the nasal flu vaccination as a cause of optic neuritis.