ACUTE POSTERIOR MULTIFOCAL PLACOID PIGMENT EPITHELIOPATHY AFTER HEPATITIS-B VACCINE

Objective: To report two cases of acute posterior multifocal placoid p igment epitheliopathy after immunization with a recombinant hepatitis B virus vaccine.Design: Case reports. Results: Two patients had develo pment of visual loss 3 days to 2 weeks after the booster administratio n of 20 mu g of recombinant hepatitis B virus surface antigen (Engerix -B). In both cases, fundus examination, fluorescein angiograms, and th e course of the disease were typical of acute posterior multifocal pla coid 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 posteri or multifocal placoid pigment epitheliopathy. Molecular mimicry betwee n a retinal pigment epithelium protein and hepatitis B surface antigen could play a role. These cases suggest an immune-mediated retinal pig ment epithelium disruption or choroidal vascular occlusions triggered by hepatitis B surface antigen.