A rare case of multisystem autoimmune disease presenting with retinopathy and alopecia post COVID-19 vaccination

To report a case of autoimmune retinopathy (AIR) with multiple systemic involvement

A 45-year-old Asian Indian male presented with progressive blurring of vision in the right eye for five years. Initial best-corrected visual acuity (BCVA) was 20/80 in RE and 20/25 in LE. Clinical evaluation was normal except for a few pigmentary alterations in the periphery. Optical coherence tomography (OCT) later revealed ellipsoid zone loss, and fundus fluorescein angiography showed peripheral venular leakage. Uveitis workup was negative except for a positive T-spot TB; Anti-tubercular therapy for nine months didn’t improve the symptoms, with BCVA declining to 20/400 in RE. Fundus autofluorescence demonstrated hypo-autofluorescence in the macula surrounded by hyper-autofluorescence. Review of history revealed dermatological features, including alopecia areata and scalp vitiligo, followed by ocular disease and systemic autoimmune abnormalities. The history also indicated onset about two months after COVID-19 vaccination. Antiretinal and other systemic antibodies were positive. The patient was diagnosed with auto immune retinopathy (AIR) and treated with mycophenolate mofetil, escalating to 1.5 g twice daily. At final follow-up 6 months later, BCVA improved to 20/200 in RE and remained stable in LE, with reduced autofluorescence abnormalities.

We report a case of multi system autoimmune disease initially presenting with dermatological features, followed by ocular and other systemic features which may have been triggered following COVID-19 vaccination in an otherwise healthy Indian male. We propose it could be a temporal event and are unable to prove a causal factor. A combination of multimodal imaging with multi-disciplinary approach helped us to come to a final diagnosis in this arduous journey for the patient.