Bilateral Relentless Placoid Chorioretinitis Following Pfizer–BioNTech COVID-19 Vaccination: Specific Antigenic Trigger or Nonspecific Immune Activation?

ABSTRACT

Purpose

To report bilateral relentless placoid chorioretinitis following Pfizer–BioNTech coronavirus disease 2019 (COVID-19) vaccine administration.

Case report

A 55-year-old Caucasian New Zealand-born woman presented with progressive left eye vision loss and bilateral photopsias and floaters occurring 10 days after receiving the Pfizer–BioNTech COVID-19 vaccination. She had a similar self-limiting episode of photopsias and floaters without vision loss 1 year prior after receiving the influenza vaccine. Snellen visual acuity (VA) was 20/25 in the right eye, and count fingers at 2 m in the left eye. Bilateral, active, creamy, plaque-like lesions were present at the level of the retinal pigment epithelium and choroid, suggestive of relentless placoid chorioretinitis. Commencement of 100 mg oral prednisolone and 3 g mycophenolate daily resulted in recovery of the foveal ellipsoid layer with VA of 20/25 in each eye after 8 weeks. Subsequent activations occurred following COVID-19 infection and respiratory infection.

Conclusion

This is the first reported case of relentless placoid chorioretinitis occurring as a potential side-effect of the Pfizer–BioNTech COVID-19 vaccine. Vaccination, and not infection, could be assumed to be the likely trigger. Subsequent flares following COVID-19 and a nonspecific respiratory infection during periods of inadequate immunosuppression suggest that a COVID-19 antigen or general immune activation could also be the trigger.

KEYWORDS:

• Coronavirus disease
• ocular inflammation
• Pfizer–BioNTech COVID-19 vaccination
• relentless placoid chorioretinitis
• vaccine side-effects

Acknowledgments

We wish to acknowledge Dr Vignesh Raja for many of the images in this manuscript.

Authorship

All authors attest that they meet the current ICMJE criteria for authorship.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Patient consent

Informed verbal and written consent was obtained from the patient. All patient identifiers were excluded.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/09273948.2023.2239338.