Acute Bilateral Photoreceptor Degeneration in an Infant After Vaccination Against Measles and Rubella

Question  What was the cause of acute vision loss after a measles and rubella vaccination in an infant boy?

Findings  A 13-month-old Japanese boy developed bilateral acute vision loss with exudative retinal detachment 24 days after a measles and rubella vaccination. The retina reattached spontaneously in few days; however, the optical coherence tomography images showed a thin outer nuclear layer and the electroretinograms were nonrecordable at 18 days after the onset.

Meaning  Vision loss after a measles and rubella vaccination is an extremely rare event and may have been coincidental or related to the vaccination.

Importance  Ocular inflammation is occasionally observed after vaccinations, and most of them resolve without permanent visual disturbances. However, there are some rare cases of severe ocular complications following vaccinations.

Objective  To report the findings in an infant boy who developed an acute loss of vision bilaterally after Haemophilus influenzae type b, Pneumococcal conjugate vaccination, and measles and rubella vaccination. His vision did not recover.

Design, Setting, and Participant  A retrospective review of the medical records of a 13-month-old Japanese boy.

Main Outcomes and Measures  Fundus and fluorescein angiographic findings, ultrasonographic and optical coherence tomographic images, and electroretinographic findings.

Results  A healthy 13-month-old boy had an acute loss of vision in both eyes 31 days after Haemophilus influenzae type b and Pneumococcal conjugate vaccinations and 24 days after a measles and rubella vaccination. He also developed a common cold 10 days before the vision loss. Ultrasonography showed an exudative retinal detachment 1 day after the onset of the visual reduction; however, his fundi appeared normal 4 days later. His eyes did not pursue objects, and pupillary light reflexes were not present. No signs of anterior uveitis were noted. He was treated with corticosteroids, but his vision did not improve. The retinal vessels gradually attenuated, and diffuse small white punctate lesions appeared in the deep retina. Optical coherence tomography showed a thinner outer nuclear layer and an absent ellipsoid zone. The electroretinograms were nonrecordable. These findings suggested a severe impairment of the photoreceptors, especially their outer segments. Western blot analysis of the patient’s sera detected an antibody against recoverin, a calcium-binding protein of photoreceptors.

Conclusions and Relevance  We hypothesize that an infection induced severe chorioretinitis with an exudative retinal detachment, which then produced an autoantibody against recoverin. The autoantibody then altered the function of the photoreceptors very rapidly. The initial infection may have been caused by the measles and rubella vaccination. However, because to our knowledge this has not been reported previously, the visual loss after the vaccinations may have been an extremely rare event that was coincidental or may have been related to the vaccination.