Central Retinal Artery Occlusion Leading to Diagnosis of Eosinophilic Granulomatous Polyangiitis After Adenovirus Vector COVID-19 Vaccination

Mary M Moses; Nathan A Fischer; Carly Elston; Bernard Dib

doi:10.1177/24741264241252588

Central Retinal Artery Occlusion Leading to Diagnosis of Eosinophilic Granulomatous Polyangiitis After Adenovirus Vector COVID-19 Vaccination

J Vitreoretin Dis. 2024 Jun 10;8(4):471-475. doi: 10.1177/24741264241252588. eCollection 2024 Jul-Aug.

Authors

Mary M Moses^{1

2}, Nathan A Fischer^{1

2}, Carly Elston³, Bernard Dib⁴

Affiliations

¹ Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
² Retina Consultants of Alabama, Birmingham, AL, USA.
³ Department of Dermatology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
⁴ Kremer Eye Center, King of Prussia, PA, USA.

PMID: 39148575
PMCID: PMC11323520 (available on 2025-06-10)
DOI: 10.1177/24741264241252588

Abstract

Purpose: To present a case of central retinal artery occlusion (CRAO) leading to the diagnosis of eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) within 1 week of an adenovirus vector COVID-19 vaccination. Methods: A case was reviewed. Results: A 50-year-old man with atopic dermatitis and asthma presented with acute painless vision loss in 1 eye. An examination and imaging findings showed CRAO. Further evaluation found eosinophilia and elevated inflammatory markers. A workup for vasculitis showed elevated cytoplasmic-antineutrophil cytoplasmic antibody, perinuclear-antineutrophil cytoplasmic antibody, myeloperoxidase antibody, rheumatoid factor, and total immunoglobulin E. Skin biopsies were consistent with eosinophilic granulomatosis with polyangiitis. Steroids, cyclophosphamide, and mepolizumab were initiated. At 1 year, the patient's systemic symptoms had improved but his vision had not. Conclusions: Few reports exist of CRAO associated with eosinophilic granulomatosis with polyangiitis, with no other instances related to an adenovirus vector COVID-19 vaccination. Treating a systemic vasculitis early can be vision saving in the fellow eye and prevent systemic life-threatening complications.

Keywords: Churg-Strauss syndrome; adenovirus vector COVID-19 vaccination; central retinal artery occlusion; eosinophilic granulomatous polyangiitis.

Publication types

Case Reports