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.