Central retinal vein occlusion post ChAdOx1 nCoV-19 vaccination – can it be explained by the two-hit hypothesis?
Abstract Purpose To report a case of central retinal vein occlusion (CRVO) seven days following the first dose of ChAdOx1 nCoV-19 vaccine and propose a hypothesis for the possible underlying pathogenesis. Observation A 31-year-old male presented with CRVO with cystoid macular edema, one week after r...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2022-10-01
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| Series: | Journal of Ophthalmic Inflammation and Infection |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12348-022-00311-4 |
| _version_ | 1797991762506022912 |
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| author | Shweta Parakh Shrey Maheshwari Shrutanjoy Das Hans Vaish Gaurav Luthra Rupesh Agrawal Vishali Gupta Saurabh Luthra |
| author_facet | Shweta Parakh Shrey Maheshwari Shrutanjoy Das Hans Vaish Gaurav Luthra Rupesh Agrawal Vishali Gupta Saurabh Luthra |
| author_sort | Shweta Parakh |
| collection | DOAJ |
| description | Abstract Purpose To report a case of central retinal vein occlusion (CRVO) seven days following the first dose of ChAdOx1 nCoV-19 vaccine and propose a hypothesis for the possible underlying pathogenesis. Observation A 31-year-old male presented with CRVO with cystoid macular edema, one week after receiving his first ChAdOx1 nCoV-19 vaccine dose. Apart from mild hyperhomocysteinemia, no major thrombophilic or systemic risk factors were found. Anti-platelet factor 4 antibodies, specific for vaccine-induced immune thrombotic thrombocytopenia, were also negative. However, he tested strongly positive (> 250 U/mL) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG spike antibodies, 2 weeks post the first dose – suggestive of a prior subclinical infection. Conclusion COVID-19 is known to be associated with an altered host one-carbon metabolism resulting in hyperhomocysteinemia. We hypothesize that a prior subclinical infection with COVID-19, the first hit, may have led to hyperhomocysteinemia in our patient and vaccination must have been the second hit that triggered the thrombotic event. Further studies, including correlation of thrombotic complications with IgG antibody titres post-vaccination, are essential in order to better understand the pathogenesis of such events. |
| first_indexed | 2024-04-11T08:57:26Z |
| format | Article |
| id | doaj.art-8f64306bae994161a0dea3537f07601f |
| institution | Directory Open Access Journal |
| issn | 1869-5760 |
| language | English |
| last_indexed | 2024-04-11T08:57:26Z |
| publishDate | 2022-10-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Journal of Ophthalmic Inflammation and Infection |
| spelling | doaj.art-8f64306bae994161a0dea3537f07601f2022-12-22T04:33:09ZengSpringerOpenJournal of Ophthalmic Inflammation and Infection1869-57602022-10-011211810.1186/s12348-022-00311-4Central retinal vein occlusion post ChAdOx1 nCoV-19 vaccination – can it be explained by the two-hit hypothesis?Shweta Parakh0Shrey Maheshwari1Shrutanjoy Das2Hans Vaish3Gaurav Luthra4Rupesh Agrawal5Vishali Gupta6Saurabh Luthra7Drishti Eye InstituteDrishti Eye InstituteDrishti Eye InstituteMeher HospitalDrishti Eye InstituteNational Healthcare Group Eye Institute, Tan Tock Seng HospitalAdvanced Eye Centre, Postgraduate Institute of Medical Education and ResearchDrishti Eye InstituteAbstract Purpose To report a case of central retinal vein occlusion (CRVO) seven days following the first dose of ChAdOx1 nCoV-19 vaccine and propose a hypothesis for the possible underlying pathogenesis. Observation A 31-year-old male presented with CRVO with cystoid macular edema, one week after receiving his first ChAdOx1 nCoV-19 vaccine dose. Apart from mild hyperhomocysteinemia, no major thrombophilic or systemic risk factors were found. Anti-platelet factor 4 antibodies, specific for vaccine-induced immune thrombotic thrombocytopenia, were also negative. However, he tested strongly positive (> 250 U/mL) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG spike antibodies, 2 weeks post the first dose – suggestive of a prior subclinical infection. Conclusion COVID-19 is known to be associated with an altered host one-carbon metabolism resulting in hyperhomocysteinemia. We hypothesize that a prior subclinical infection with COVID-19, the first hit, may have led to hyperhomocysteinemia in our patient and vaccination must have been the second hit that triggered the thrombotic event. Further studies, including correlation of thrombotic complications with IgG antibody titres post-vaccination, are essential in order to better understand the pathogenesis of such events.https://doi.org/10.1186/s12348-022-00311-4ChAdOx1 nCoV-19 vaccineCentral retinal vein occlusion (CRVO)Vaccine-induced immune thrombotic thrombocytopenia (VITT)Anti-PF4 antibodiesSARS-CoV-2Two-hit hypothesis |
| spellingShingle | Shweta Parakh Shrey Maheshwari Shrutanjoy Das Hans Vaish Gaurav Luthra Rupesh Agrawal Vishali Gupta Saurabh Luthra Central retinal vein occlusion post ChAdOx1 nCoV-19 vaccination – can it be explained by the two-hit hypothesis? Journal of Ophthalmic Inflammation and Infection ChAdOx1 nCoV-19 vaccine Central retinal vein occlusion (CRVO) Vaccine-induced immune thrombotic thrombocytopenia (VITT) Anti-PF4 antibodies SARS-CoV-2 Two-hit hypothesis |
| title | Central retinal vein occlusion post ChAdOx1 nCoV-19 vaccination – can it be explained by the two-hit hypothesis? |
| title_full | Central retinal vein occlusion post ChAdOx1 nCoV-19 vaccination – can it be explained by the two-hit hypothesis? |
| title_fullStr | Central retinal vein occlusion post ChAdOx1 nCoV-19 vaccination – can it be explained by the two-hit hypothesis? |
| title_full_unstemmed | Central retinal vein occlusion post ChAdOx1 nCoV-19 vaccination – can it be explained by the two-hit hypothesis? |
| title_short | Central retinal vein occlusion post ChAdOx1 nCoV-19 vaccination – can it be explained by the two-hit hypothesis? |
| title_sort | central retinal vein occlusion post chadox1 ncov 19 vaccination can it be explained by the two hit hypothesis |
| topic | ChAdOx1 nCoV-19 vaccine Central retinal vein occlusion (CRVO) Vaccine-induced immune thrombotic thrombocytopenia (VITT) Anti-PF4 antibodies SARS-CoV-2 Two-hit hypothesis |
| url | https://doi.org/10.1186/s12348-022-00311-4 |
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