Optic neuropathy after influenza vaccination

The authors described a case of a 6-year-old girl who developed bilateral optic neuritis following inactivated influenza vaccination.

Study design

A previously healthy 6-year-old developed bilateral retrobulbar optic neuritis 1 week following inactivated influenza vaccination, which was supported by long segment enhancement of both optic nerves on orbital MRI. Her identical twin received the same vaccine but did not develop any changes to her vision.

Outcomes

Following a negative serological workup for other autoimmune or CNS disorders, clinicians treated her with high-dose oral prednisone. She had full recovery of vision in both eyes with no recurrence of vision loss at the last follow-up of approximately 3 months.

Limitations

Given this is an anecdotal case report, true causality is difficult to establish. Nonetheless, the temporal relationship, plausible pathophysiological mechanism and literature precedent makes the potential association compelling.

Clinical significance

Influenza vaccination is extremely common and administered routinely on an annual basis worldwide. Although an adverse event of optic neuritis is extremely uncommon—estimated at 0.003/100,000 vaccines—clinicians should be aware of this possible clinical presentation, given that the prognosis for visual recovery is good when treated promptly with systemic steroids.

A syndrome termed ASIA (autoimmune/inflammatory clinical syndromes induced by adjuvants) was coined in 2011, and describes the potential for vaccine adjuvants (i.e., potentiators) to trigger an exaggerated, hyperactive immune response. The impact of recognizing such reactions in our patients can be significant. Prompt recognition of this entity can lead to effective, timely treatment and better outcomes.