Optic neuritis following diphtheria, tetanus, pertussis, and inactivated poliovirus combined vaccination: a case report
Diphtheria, tetanus, pertussis, and inactivated poliovirus combined vaccine is widely used in young children as part of a series of immunizations before they start attending school. Case studies of demyelinating conditions following administration of diphtheria, tetanus, pertussis, and polio vaccine have been reported, but none so far resulting in optic neuritis. This report further contributes to the database of central nervous system demyelinating conditions affiliated with receipt of vaccines.
A previously healthy 27-year-old Hispanic man presented to an emergency department with headache, periorbital pressure, pain with ocular movements, and intermittent blurred vision that developed 1 day after administration of the diphtheria, tetanus, pertussis, and inactivated poliovirus combined vaccine. A diagnosis of optic neuritis was made via ophthalmic examination with fundus photography and automated Humphrey visual field analysis. His vision recovered following treatment with high-dose intravenously administered methylprednisolone followed by a tapered dose of orally administered prednisolone.
Although the association between immunizations and the onset of central nervous system demyelinating conditions is well documented, this report, to the best of our knowledge, is the first case of optic neuritis following diphtheria, tetanus, pertussis, and inactivated poliovirus combined vaccination. Inclusion of this case report in the medical community will allow for broader understanding of possible conditions that may present shortly after receipt of vaccination.
KeywordsDiphtheria Tetanus Pertussis Virus Optic neuritis
Cytoplasmic antineutrophil cytoplasmic antibodies
Central nervous system
Diphtheria, tetanus, pertussis and inactivated poliovirus combined vaccine
Fluorescent treponemal antibody absorption
Perinuclear antineutrophil cytoplasmic antibodies
Rapid plasma reagin
Diphtheria, tetanus, pertussis, and inactivated poliovirus combined vaccine (DTaP-IPV) is widely used in young children as part of a series of immunizations before they start attending school. Although clinical trials have shown an excellent safety profile , there have been reports of encephalitis, angioneurotic edema, seizures, and serious local reactions following its administration [1, 2]. Although cases of central nervous system (CNS) demyelinating conditions following DTaP-IPV vaccine have been reported , to the best of our knowledge, we present the first case of optic neuritis.
A 27-year-old Hispanic man with no significant past medical history presented to an emergency department with a 5-day history of headache, pain with ocular movements, and intermittent blurred vision starting 1 day after being immunized with DTaP-IPV. Magnetic resonance imaging and a magnetic resonance venogram of his brain were unremarkable. A lumbar puncture revealed a normal opening pressure and cerebrospinal fluid studies were positive for myelin basic protein but negative for oligoclonal bands and neuromyelitis optica autoantibody serology.
He was diagnosed as having DTaP-IPV vaccination-related optic neuritis and started on intravenously administered Solu-Medrol (methylprednisolone). One week later, his headache resolved and vision improved to 20/20 in his right eye and 20/25 in his left eye with less optic nerve hyperemia and swelling. He was discharged on a prednisone taper and an orally administered diabetic medication. One month later, his vision improved to 20/20 with resolution of the optic neuritis without residual visual field deficit in both eyes.
In 2008, the DTaP-IPV vaccine was licensed and indicated for use in children of 4–6 years in age. From 2009 to 2012, a large-scale trial monitoring for adverse events found no significant increased risk of meningitis or encephalitis following DTaP-IPV . Although the overall risk of developing a demyelinating CNS syndrome after vaccination is relatively low (estimated to be 0.1%), it is not negligible . Molecular mimicry from the viral proteins or the adjuvants used in the preparation of the vaccine have been suspected in the development of demyelinating disease following vaccination [3, 4]. Molecular mimicry occurs when similarities exist between proteins of viruses used in vaccinations and the components of CNS myelin which may disrupt self-tolerance and cause production of autoantibodies resulting in CNS inflammation including optic neuritis [3, 5]. Our case is consistent with other cases of post-vaccination optic neuritis, most of which develop 1–3 weeks after vaccination, typical of an immune-triggered mechanism .
In most cases, symptoms of optic neuritis were mostly resolved after treatment with steroids such as intravenously administered methylprednisolone followed by tapered oral prednisolone for several weeks [3, 5]. Early recognition of ocular signs and symptoms of optic neuritis following DTaP-IPV vaccination may lead to prompt treatment and preserved vision.
Although the association between immunizations and the onset of CNS demyelinating conditions is well documented, this report, to the best of our knowledge, is the first case of optic neuritis following DTaP-IPV vaccination. Inclusion of this case report in the medical community will allow for broader understanding of possible conditions that may present shortly after receipt of vaccination.
There are no other sources of funding.
Availability of data and materials
The authors agree to making the images and data described in the manuscript freely available for use.
Both PO and RW contributed equally to the design, drafting, and editing of this manuscript. Both authors read and approved the final manuscript.
Ethics approval and consent to participate
The study was sent to the University of Texas at Austin Institutional Review Board and need for further approval was waived.
Consent for publication
Written and informed consent was obtained from the patient for publication of the case report and the accompanying images. Copies of the written consent forms are available for review by the Editor-in-Chief of this journal.
The authors declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.