Panuveitis following administration of quadrivalent human papillomavirus vaccine

Yu-Hung Chen^a, Ying-Hsiu Chang^b, Yuan-Chieh Lee^{c, d, e}

a Department of Nuclear Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
b Department of Emergency, National Taiwan University Hospital, Taipei, Taiwan
c Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
d Department of Medicine, Tzu Chi University, Hualien, Taiwan
e Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan

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Abstract
A 27-year-old woman had acute panuveitis, associated with bilateral knee pain with morning stiffness, erythematous papules on the bilateral anterior legs, vertigo, and hearing impairment 4 days after administration of the third dose of quadrivalent human papillomavirus vaccine (HPV4). The only abnormal laboratory finding was an elevated erythrocyte sedimentation rate. Skin biopsy of the local erythematous papules disclosed septal panniculitis with lymphocytic vasculitis. Complete remission was achieved with oral and topical steroids for 4 months. There was no recurrence in the following 2 years. Ophthalmologists and primary-care physicians should be aware of this possible adverse reaction to HPV4.

Keywords
Lymphocytic vasculitis; Panuveitis; Quadrivalent human papillomavirus vaccine