GSK-137173A

Abstract

Uveitis reactivation: 3 case reports In a case series three patients (two women and one man) aged 57-70years were described, who developed Uveitis reactivation following administration of GSK-137173A. Case 1: A 57-year-old female, who had a medical history of bilateral multifocal choroiditis (managed with methotrexate), received GSK-137173A [recombinant zoster vaccine]. Five days later, she presented due to an acute decrease in vision in the right eye (OD) and new metamorphopsia in the left eye (OU). She also reported upper arm swelling at the injection site, chills, malaise, subjective fever and tinnitus, it was developed in following 24h of the vaccination. Investigations revealed count fingers vision eccentrically OD (baseline acuity 20/40) and 20/20–2 vision OS with correction. Intraocular pressure was within the normal range for both of the eyes. Pupils were equal, round, and reactive to light, without evidence of a relative afferent pupillary defect. Slit-lamp test revealed a quiescent anterior segment OU and an occasional anterior vitreous cell OD without vitreous haze in either of the eye. In the right eye, stable posterior segment findings including peripapillary atrophic scarring with temporal thinning of the optic nerve, confluent circular punched-out atrophic macular scars with a small spared foveal region and vessel attenuation was noted. In the left eye, a linear yellow scar temporal to the fovea and a new yellow chorioretinal lesion adjacent to this scar was observed. Fundus auto fluorescence revealed stable hypoautofluorescence in the area of prior retinal scars OD and a new area of hyperautoflurorescence at the site of the new lesion OS. Ocular coherence tomography (OCT) revealed persistent results, when they were compared with it showed atrophy and scarring previously. The macular OCT OS revealed a new outer retinal lesion temporal to prior residual scar. The woman was then treated with prednisone, and continued receiving methotrexate. One week later, at follow-up, she demonstrated alleviated metamorphopsia in the left eye. Visual acuity was improved to 20/250 OD and remained at 20/20–2 OS. Ocular investigations were stable for OD and the new lesion noted on the OS, it was observed prior to ocular investion and was less elevated. Over the two months, her prednisone was tapered without recurrent inflammation; however, she developed secondary choroidal neovascular membrane at the edge of the new scar [aetiology not stated], it was managed with bevacizumab. Case 2: A 69-year-old man, who had a medical history of idiopathic recurrent bilateral anterior and mild intermediate uveitis, received GSK-137173A [recombinant zoster vaccine]. One month later, he presented due to sudden onset headache and blurred vision in the right eye. He had completed therapy with prednisone 3 months and 2 months for OD and OS, respectively. Investigations at that time revealed quiescent uveitis. On presentation, investigations revealed best corrected vision was 20/50 OD and 20/30 in the unaffected OS. Intraocular pressure was found within normal range. Further investigations revealed several foci of anterior stromal keratitis, stellate keratic precipitates and trace anterior chamber cell OD. Then he underwent pentacam optical densitometry of the cornea. It revealed loss of clarity in the regions of stromal keratitis. The man was then treated with valaciclovir. After 3 days, he showed a significant improvement. Then he was treated with prednisolone At 1 month follow-up, his vision and clinical condition improved. Case 3: A 70-year-old woman, who had a medical history of recurrent unilateral anterior uveitis and corneal neovascularization with lipid keratopathy of OS, received first dose of GSK-137173A [recombinant zoster vaccine] and presented two weeks later due to mildly decreased vision of the left eye. Six months previously, she had completed course of valaciclovir and loteprednol etabonate. Her uveitis was quiescent 4 months previously; however, following GSK-137173A, she developed 1+ anterior chamber cell and new keratic precipitates in the left eye. She was then treated with valaciclovir and prednisolone. Six weeks later, her symptoms were quiescent.