Acute posterior multifocal placoid pigment epitheliopathy after hepatitis B vaccine
A. P. Brezin, P. Massin-Korobelnik, M. Boudin, A. Gaudric and P. LeHoang
Hopital Pitie-Salpetriere, Paris, France.
OBJECTIVE: To report two cases of acute posterior multifocal placoid
pigment epitheliopathy after immunization with a recombinant hepatitis B
virus vaccine. DESIGN: Case reports. RESULTS: Two patients had development
of visual loss 3 days to 2 weeks after the booster administration of 20
micrograms of recombinant hepatitis B virus surface antigen (Engerix-B). In
both cases, fundus examination, fluorescein angiograms, and the course of
the disease were typical of acute posterior multifocal placoid pigment
epitheliopathy. In case 1, 1 week after immunization, the leukocyte count
was 10.3 X 10(9)/L with 24% polynuclear eosinophils (2.47 X 10(9)/L); in
case 2, blood cell counts were normal. CONCLUSION: Hepatitis B virus
immunization may be a risk factor for acute posterior multifocal placoid
pigment epitheliopathy. Molecular mimicry between a retinal pigment
epithelium protein and hepatitis B surface antigen could play a role. These
cases suggest an immune-mediated retinal pigment epithelium disruption or
choroidal vascular occlusions triggered by hepatitis B surface antigen.
