Uveomeningeal syndrome presenting with bilateral optic disc edema and multiple evanescent white dots syndrome (MEWDS)

Zachary C Wiley; Mohammad Pakravan; Chaow Charoenkijkajorn; Shawn C Kavoussi; Andrew G Lee

doi:10.1016/j.ajoc.2022.101538

Uveomeningeal syndrome presenting with bilateral optic disc edema and multiple evanescent white dots syndrome (MEWDS)

Am J Ophthalmol Case Rep. 2022 Apr 20:26:101538. doi: 10.1016/j.ajoc.2022.101538. eCollection 2022 Jun.

Authors

Zachary C Wiley¹, Mohammad Pakravan², Chaow Charoenkijkajorn², Shawn C Kavoussi², Andrew G Lee^{2

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Affiliations

¹ Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA.
² Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA.
³ Department of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA.
⁴ Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA.
⁵ University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁶ Texas A and M College of Medicine, Bryan, TX, USA.
⁷ Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA.

Abstract

Purpose: To report a uveomeningeal syndrome with bilateral optic disc edema and a MEWDS-like presentation.

Observations: A 17-year-old female experienced daily fevers for 3 days (ranging from 101.4 F to 102 F), then received the first dose of the Pfizer SARS-CoV-2 vaccine nearly three weeks later. Within two days she experienced severe headaches with severity scale of 8/10. Retinal imaging at the time showed optic disc edema in both eyes (OU) and multifocal well-circumscribed chorioretinal white lesions in the periphery OU. Neuroimaging and routine infectious and inflammatory laboratory testing were normal. Lumbar puncture showed elevated opening pressure and cerebrospinal pleocytosis consistent with an aseptic meningitis. At follow up, one month later the symptoms and retinal findings resolved.

Conclusions: MEWDS is typically an idiopathic condition but can occur in the setting of viral illness. Although other white dot syndromes have been associated with uveomeningeal presentations, to our knowledge this is the first such case to be described in the English language ophthalmic literature.

Keywords: COVID; MEWDS; White dots syndrome.

Publication types

Case Reports