Unilateral uveitis following adjuvanted Varicella-Zoster subunit vaccine in a patient with previously resolved Varicella Zoster acute retinal necrosis

Purpose: To report a case of intraocular inflammation following adjuvanted recombinant Varicella-Zoster subunit vaccine (RZV) in a patient with previously resolved VZV-related acute retinal necrosis (ARN). Methods: Single case report. Multimodal imaging, including true-color fundus photography, spectral-domain (SD-OCT) and dye-based angiography, was used to evaluate the retinal alterations. Results: A 73-year-old male, with past history of VZV-related acute retinal necrosis (ARN) developed unilateral cystoid macular edema and diffuse blood-retinal barrier (BRB) breakdown in the affected eye after receiving the second dose of RZV vaccine. A complete resolution of this complication was observed after a short course of systemic corticosteroids. Conclusion: Our case suggests a possible pathogen-specific intraocular inflammatory reaction, resembling immune reconstitution uveitis (IRU), following RZV administration in a patient with previously resolved VZV-related ARN. While RZV remains safe, intraocular inflammation should be considered as a possible side effect in patients with previously resolved VZV uveitis.