Chen Jinghua, Peltzer Cadynce, Buchowicz Bryce, Dawson Slaney Elizabeth, Maleki Arash
Department of Ophthalmology, College of Medicine, Gainesville, FL, USA.
NSU Dr. Kiran C. Patel College of Osteopathic Medicine - Tampa Bay Regional Campus, Tampa, FL, USA.
Case Rep Ophthalmol. 2023 Apr 18;14(1):173-179. doi: 10.1159/000529770. eCollection 2023 Jan-Dec.
Thromboembolic events as a result of COVID-19 mRNA vaccination are a rare, though life-threatening complication. In this case report, we describe a 40-year-old female patient who developed central retinal artery and ophthalmic artery occlusion progressing to intracranial thrombosis 3 weeks after vaccination with the Pfizer-BioNTech COVID-19 vaccine. Initially, she presented with progressive acute and painless unilateral vision loss in her left eye. Dilated fundoscopy of left eye showed macular whitening with sparing of the area of cilioretinal artery distribution. Labs revealed a normal erythrocyte sedimentation rate, C-reactive protein, and platelet count. Computerized tomography angiography of the head and neck showed an occlusion of the entire left cervical internal carotid artery and occlusion of the origin of the left external carotid artery. Despite treatment with heparin, her vision declined to no light perception. Ten days later, the patient presented with right peripheral vision loss and was found to have a new left posterior cerebral artery/posterior inferior cerebellar artery stroke. Seventeen days later, she presented to the hospital with nausea and vertigo and was found to have a subacute infarction in the left parietal lobe corresponding to left anterior communicating artery/middle cerebral artery watershed territory. Hypercoagulable disorders, vasculitis, cardiac arrhythmias, and intraventricular thrombi were excluded. Fundus fluorescein angiography confirmed central retinal artery occlusion and ophthalmic artery occlusion with impressive retina and choroid changes in fluorescein angiography patterns. This complication of mRNA COVID-19 vaccination has not been previously described in the literature and should be considered even weeks after initial presentation.
新型冠状病毒肺炎（COVID-19）信使核糖核酸（mRNA）疫苗接种导致的血栓栓塞事件是一种罕见但危及生命的并发症。在本病例报告中，我们描述了一名40岁女性患者，在接种辉瑞-BioNTech COVID-19疫苗3周后发生了视网膜中央动脉和眼动脉闭塞，并进展为颅内血栓形成。最初，她出现左眼进行性急性无痛性单眼视力丧失。左眼散瞳眼底检查显示黄斑变白，睫状视网膜动脉分布区域未受累。实验室检查显示红细胞沉降率、C反应蛋白和血小板计数正常。头颈部计算机断层血管造影显示左侧颈内动脉全程闭塞以及左侧颈外动脉起始部闭塞。尽管接受了肝素治疗，她的视力仍下降至无光感。10天后，患者出现右眼周边视力丧失，发现有新的左侧大脑后动脉/小脑后下动脉卒中。17天后，她因恶心和眩晕入院，发现左侧顶叶有亚急性梗死，对应于左侧前交通动脉/大脑中动脉分水岭区域。排除了高凝性疾病、血管炎、心律失常和脑室内血栓。眼底荧光血管造影证实视网膜中央动脉闭塞和眼动脉闭塞，荧光血管造影模式显示视网膜和脉络膜有明显变化。这种mRNA COVID-19疫苗接种的并发症此前在文献中未曾描述，即使在初次出现数周后也应予以考虑。
