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Antoine P. Brézin, MD; Pascale Massin-Korobelnik, MD; Michel Boudin, MD; Alain Gaudric, MD; Phuc LeHoang, MD

Arch Ophthalmol. 1995;113(3):297-300.

Abstract
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 µg 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 10.3x10⁹/L with 24% polynuclear eosinophils (2.47x10⁹/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.

Author Affiliations
From the Hôpital Pitié-Salpêtrière, Paris, France (Drs Brézin and LeHoang); Centre Hospitalier, Le Mans, France (Dr Boudin); and Hôpital Lariboisière, Paris (Drs Massin-Korobelnik and Gaudric).

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