Chu Chiang, Jiang Shin-Kuang, Shao Yi-Ching, Yeh Su-Peng
Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
Division of Neurology, China Medical University Hospital, Taichung, Taiwan.
Front Med (Lausanne). 2023 Jun 20;10:1177610. doi: 10.3389/fmed.2023.1177610. eCollection 2023.
Hematopoietic stem cell transplantation (HSCT) recipients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have a high mortality rate. The American Society of Transplantation and Cellular Therapy (ASTCT) and the European Society for Blood and Marrow Transplantation (EBMT) recommend vaccination for these vulnerable populations. However, emerging data suggested that vaccination might elicit immunological adverse events, including an exacerbation of graft-vs.-host disease (GVHD). Herein, we report a case of severe optic neuritis developed shortly after AstraZeneca COVID-19 vaccination in an allogeneic HSCT recipient with underlying chronic GVHD. The patient had a headache 5 days after vaccination, and the disease progressed rapidly to complete blindness 17 days after the vaccination. The diagnosis of optic neuritis was well-confirmed by the presence of an anti-myelin oligodendrocyte glycoprotein antibody and the typical features of MRI image and Ophthalmoscopy. Other differential diagnoses, such as infection or leukemia relapse in the central nervous system (CNS), were carefully excluded. A timely high-dose corticosteroid was administered, and her visual acuity improved rapidly. She returned to her baseline status 1 month later. With more than 1 year of follow-up, no optic neuritis or leukemia relapse was observed. In summary, allogeneic transplant recipients can develop severe optic neuritis after vaccination. Optic neuritis can be an exacerbation of GVHD or rarely a sporadic adverse event of vaccination. Furthermore, our experience indicates that a prompt diagnosis and early steroid treatment are vital for a good recovery.
受严重急性呼吸综合征冠状病毒2（SARS-CoV-2）影响的造血干细胞移植（HSCT）受者死亡率很高。美国移植与细胞治疗学会（ASTCT）和欧洲血液与骨髓移植学会（EBMT）建议为这些脆弱人群接种疫苗。然而，新出现的数据表明，接种疫苗可能引发免疫不良事件，包括移植物抗宿主病（GVHD）加重。在此，我们报告一例异基因造血干细胞移植受者在接种阿斯利康新冠疫苗后不久发生严重视神经炎的病例，该受者患有潜在慢性移植物抗宿主病。患者在接种疫苗5天后出现头痛，在接种疫苗17天后病情迅速发展至完全失明。抗髓鞘少突胶质细胞糖蛋白抗体的存在以及MRI图像和眼底镜检查的典型特征充分证实了视神经炎的诊断。仔细排除了其他鉴别诊断，如中枢神经系统（CNS）感染或白血病复发。及时给予高剂量皮质类固醇治疗，患者视力迅速改善。1个月后她恢复到基线状态。经过1年多的随访，未观察到视神经炎或白血病复发。总之，异基因移植受者在接种疫苗后可能发生严重视神经炎。视神经炎可能是移植物抗宿主病的加重，或很少是接种疫苗的散发性不良事件。此外，我们的经验表明，及时诊断和早期类固醇治疗对于良好恢复至关重要。
