Case Presentation
A 52-year-old woman presented with redness in both eyes for one week
(Figure1). She had no history of hypersensitivity reaction or similar
events. The patient first developed right eye redness 3 days following
the third dose of inactivated Sinopharm vaccine (BBIBP- CorV), which
spread to the left side 3 days after. In physical examination, the
patient’s vital signs were normal and stable, without respiratory
distress and fever. No signs of lymphadenopathy or splenomegaly were
detected. The patient’s neurological examination was unremarkable. The
ophthalmic evaluation showed no signs and symptoms of eye discharge,
pain, photophobia, and itching. Besides, the patient had a remarkable
past medical history of pterygium on her left eye conjunctiva in the
past year, well controlled. The oculist reported her visual acuity to be
20/20 OU before. Slit lamp examination showed anterior diffused
scleritis with negative phenylephrine test results. There was no sign of
inflammation or the existence of cells.
Laboratory results showed elevated levels of CRP, and ESR to be 9.1
(positive: >9), and 39 (positive>30).
Moreover, liver function tests, kidney function tests, albumin, total
protein, PANCA and anti-MPO, CANCA and Anti PR3, FANA, ds cryoglobulins,
C3, C4, anti-dsDNA, serology tests for HCV, HBV and HIV were negative or
normal (Table 1). Also, the results of stool examination and urinalysis
did not reveal any findings in favor of renal disorders or infectious
diseases.
Radiological evaluation with a CXR and computed tomography scan did not
show any notable findings. Echocardiography and electrocardiogram showed
no abnormal findings without any systolic or diastolic dysfunction and
with normal EF. EMG-NCV were normal.
By merging all the information obtained from the patient’s symptoms and
clinical evaluations, and the recent COVID-19 vaccine, scleritis as an
autoimmune reaction induced by Sinopharm COVID-19 vaccination was
approved after all assessments.
She was administered a tapering dose of prednisolone (30mg at the
start), followed by azathioprine (50mg/day) to control the episode.
After two weeks, the scleritis completely resolved.