Sudden Bilateral Vision Loss: A Case Report of Frosted Branch Angiitis Following Pentavalent Vaccination in a 2-Year-Old Boy

Sudden Bilateral Vision Loss: A Case Report of Frosted Branch Angiitis Following Pentavalent Vaccination in a 2-Year-Old Boy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Sudden Bilateral Vision Loss: A Case Report of Frosted Branch Angiitis Following Pentavalent Vaccination in a 2-Year-Old Boy Mohammed Falah Aljasir, Dhoha Mohammed Alhamad, Shahad Salah Alsubhi, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5440098/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 26 Feb, 2025 Read the published version in Journal of Ophthalmic Inflammation and Infection → Version 1 posted 13 You are reading this latest preprint version Abstract Background Frosted branch angiitis (FBA) is a rare form of retinal vasculitis that can lead to significant vision loss. This case report presents a unique case of idiopathic FBA in a 2-year-old boy following pentavalent vaccination. Case Presentation: A previously healthy 2-year-old Emirati boy presented with sudden painless bilateral vision loss for one day. His mother noted difficulty walking downstairs and a lack of interest in visual stimuli. Ten days prior, he received the pentavalent vaccination in the UAE. Ophthalmic examination revealed bilateral dilated pupils, anterior chamber inflammation, and extensive retinal vascular sheathing. Investigations were unremarkable, leading to a diagnosis of idiopathic FBA. The patient was treated with oral Prednisolone and Acyclovir. Within two weeks, the vision improved significantly, with complete resolution of retinal vasculitis observed within one month. Follow-up over one year showed no recurrence, although small white scars remained in both eyes. Conclusion This case highlights the potential association between pentavalent vaccination and the onset of idiopathic FBA. Prompt recognition and treatment with systemic steroids can lead to favorable outcomes, emphasizing the importance of monitoring visual symptoms in pediatric patients following vaccination. Frosted branch angiitis Uveitis Bilateral vision loss Pentavalent vaccination Viral infection Figures Figure 1 Figure 2 Figure 3 Introduction/ Background Sudden visual disability in children could be an uncommon but serious and disturbing condition that requires prompt evaluation and intervention. The causes of bilateral vision loss are diverse, ranging from traumatic injuries and infectious diseases to neurovascular events and psychiatric conditions. 1 Frosted branch angiitis (FBA) is an uncommon pan-uveitic disease characterized by vasculitis affecting the entire retina. While it typically presents bilaterally, unilateral cases do not rule out the diagnosis. The etiology of FBA is varied and may be idiopathic, traumatic, infectious, or related to other factors. Infectious agents associated with FBA include cytomegalovirus (CMV), acquired immunodeficiency syndrome (AIDS), herpes simplex virus (HSV), varicella-zoster virus (VZV), Epstein-Barr virus (EBV), influenza type A, tuberculosis, toxoplasmosis, glomerulonephritis, and Streptococcus. Additionally, autoimmune disorders such as Behçet's disease, systemic lupus erythematosus, antiphospholipid syndrome, Crohn's disease, and Wegener's granulomatosis may also contribute, along with malignancies like large cell lymphoma, acute lymphoblastic leukemia, and Hodgkin's lymphoma. 2 , 3 Therefore, prompt attention is crucial for identifying the specific etiology. 2 , 4 It has been observed that most cases occur in individuals aged 2 to 42. 3 , 5 FBA is characterized by vascular inflammation, retinal oedema, vision loss, and significant retinal vascular sheathing of both arterioles and venules. 5 Fundus examination reveals the inflamed retinal vessels, which resemble a distinctive appearance as frosted branches of a tree. 3 , 4 , 5 This case report describes the first case of idiopathic FBA in a 2-year-old child following pentavalent vaccination. Case Presentation A 2-year-old Emirati boy, heterozygous twin A, medically free, full-term presented to the emergency department at Dhahran Eye Specialist Hospital in the Kingdom of Saudi Arabia with sudden painless vision loss in both eyes for one day. The patient’s mother noticed that the child could not walk down the stairs, was looking into plank, and was not interested in the television, which she believed was due to the bilateral sudden vision loss. Ten days prior to the presentation, the child received the pentavalent vaccination in the United Arab Emirates. The patient had no significant past medical history other than one episode of febrile seizure six months ago. The prenatal and natal histories were unremarkable. Review of systems was negative except for common cold symptoms including runny nose and diarrhea, which had been progressing over the past five days, associated with mild fever that lasted for one day only. The mother denied any history of trauma, loss of consciousness, skin rash, mouth ulcers, or joint pain. Detailed ophthalmic examination showed that the child could not fix or follow an object. The pupils were bilaterally dilated and non-reactive. Anterior segment examination revealed + 3 pigmented cells in the anterior chamber in both eyes. Dilated fundoscopy showed hazy vitreous, hyperemic discs, and extensive vascular sheathing in all quadrants in both eyes. (Fig. 1 ) Fundus fluorescein angiography (FFA) demonstrated diffuse vascular leakage, including optic disc leakage (Fig. 2 ), as well as peripheral capillary dropout (Fig. 3 ). Polymerase chain reaction (PCR) analysis and culture of aqueous fluid of VZV, HSV, and CMV were normal. Furthermore, thorough blood investigations including complete blood count, liver function tests, renal function tests, blood PCR of VZV, HSV and CMV, Syphilis, Human Immunodeficiency Virus (HIV), Toxoplasma latex, Purified Protein Derivative (PPD), Human Leukocyte Antigen (HLA) B27, HLA B51, Anti-Cardiolipin (IgG, IgM), Cytoplasmic Antineutrophil Cytoplasmic Antibodies (C-ANCA), Perinuclear Antineutrophil Cytoplasmic Antibodies (P-ANCA), rheumatoid factor, chest x-ray, and brain Magnetic Resonance Imaging (MRI) were done, all of them were within normal, except high erythrocyte sedimentation rate (ESR) with a level of 26 mm/1h. A comprehensive evaluation with full systemic examination was conducted by a pediatrician. It was inconclusive and the patient was labeled as a case of idiopathic FBA. As a result, oral Prednisolone tapering of 2 mg/kg/day and Acyclovir 200 mg five times a day were prescribed over one month. Close follow-up was started with plans for tapering therapy as the patient improved. Two weeks after starting the treatment, the patient's vision progressed to the ability to focus and follow with both eyes. The retinal findings showed almost complete resolution of the vasculitis. One month later, a fundus examination showed complete resolution of vasculitis in both eyes. Over one year of follow-up, there was no recurrence of vasculitis; however, small multifocal white scars were observed and remained present in both eyes. Electroretinogram (ERG) suggested dysfunction of the macular-visual pathway. Visual evoked potential (VEP) was done and showed a normal response. The patient was evaluated by a pediatric rheumatologist and immunologist who ruled out underlying systemic diseases. Discussions We present a unique case of a 2-year-old child with idiopathic FBA following the pentavalent vaccination. FBA is a rare and unique type of uveitis associated with retinal vasculitis resembling the distinctive appearance of frosted branches of a tree. 3 , 4 , 5 The predominant reported cases were of young and healthy patients, with a peak incidence in children and third decade of life. 3 , 5 Most of FBA patients presented with bilateral subacute vision loss associated with floaters and photopsia. 4 As described previously, the etiologies of FBA are variable, it could be idiopathic, traumatic, infective, or post-vaccination. There were several reported cases of FBA after receiving vaccination such as [small-pox, mMRNA-1273 COVID-19, booster of BNT162b2 against SARS-CoV-2, and triple vaccine (diphtheria, pertussis, and tetanus)], but none of them were due to the Pentavalent vaccination. 6 , 7 , 8 , 9 In the United Arab Emirates, the pentavalent vaccination is a combined vaccine against five killer diseases: diphtheria, pertussis, tetanus, haemophilus influenzae type B, and hepatitis B. 10 In 1967 a case was reported of a 6-year-old Japanese boy who had bilateral FBA after receiving the triple vaccination of diphtheria, pertussis, and tetanus. He presented initially with visual acuity (VA) of hand motion and counting fingers in the right and left eye, respectively. Five months after administration of steroids and isoniazid, the VA improved to 6/60 and 6/12 in the right and left eye, respectively. 9 Similarly, our patient presented with signs and symptoms of FBA shortly after the pentavalent vaccine. The patient initially was unable to fix or follow an object. Two weeks after receiving a tapering dose of oral Prednisolone and Acyclovir, the patient's vision progressed to the ability to focus and follow with both eyes. Other subtypes of the pentavalent vaccine, mainly the hepatitis B virus (HBV) vaccine, are associated with other types of ocular uveitis. 11 , 12 Uveitic diseases post HBV vaccine include acute posterior multifocal placoid pigment epitheliopathy, multiple evanescent white dot syndrome, Vogt–Koyanagi–Harada syndrome, paracentral acute middle maculopathy, and posterior uveitis. 12 , 13 HBV vaccination has also been reported to be associated with optic neuritis. 14 Administration of combined vaccines of diphtheria, tetanus, pertussis, and inactivated poliovirus, has been shown to be associated with optic neuritis. 15 Other etiologies of FBA in the pediatric population include infectious diseases like upper respiratory tract infection, CMV, VZV, pneumonia, COVID-19, EBV, toxoplasmosis, mumps, and HIV. 3 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 Many cases remain due to an unknown etiology. 3 , 24 , 25 , 26 Some cases due to autoimmune diseases like systemic juvenile idiopathic arthritis, SLE, and Behcet disease. 3 , 4 , 27 , 28 A couple of cases presented with headache only without a known specific etiology. A handful of cases presented with fever only as the predominant symptom. In addition, one case was associated with fever and sepsis and another child had fever and rash only. 3 Finally, a single case of a child with Langerhans cell histiocytosis on clofarabine. 29 As a result, many differential diagnoses were considered. However, our patient’s laboratory tests ruled out any association with syphilitic, herpetic, or tubercular infection. However, COVID-19 PCR was not obtained. The child had no other systemic or ophthalmic signs or symptoms that suggested other etiology. Leukemia or lymphoma were ruled out since there was no history or laboratory findings to suggest such diseases. Treatment of FBA varies depending on the etiology. Infectious causes are treated with antimicrobial therapy, while inflammatory etiologies are resolved with anti-inflammatory agents. Most of FBA patients treated with systemic steroids showed rapid resolution of symptoms with good visual recovery. Acyclovir has been given in a minority of cases. 3 The management of the four reported cases of FBA secondary to vaccination included: systemic steroids for one patient; a combination of systemic steroids and antimicrobial therapy (isoniazid) or antiviral therapy (acyclovir) for two patients; and systemic steroids followed by vitrectomy for the last patient, who had an uneventful recurrent disease. 6 , 7 , 8 , 9 In our patient, the signs and symptoms of the common cold and the high ESR level suggested a potential of viral infection. Thus, oral Prednisolone and Acyclovir were given to prevent further progression of the retinal vasculitis. The prognosis of FBA has not always been promising with recovery time varying from one case to another. Regaining good visual outcomes ranged from less than a month in the majority of the cases, while in only a minority of cases, the recovery time was longer. Complications secondary to FBA include macular scarring, retinal vein or artery occlusion, macular epiretinal membrane formation, diffuse retinal fibrosis, retinal tear formation, vitreous hemorrhage, optic disc atrophy, and peripheral atrophic retinal lesions. 3 Our patient showed progressive improvement within two weeks. Ended with complete resolution of vasculitis in less than one month with only remnant of small multifocal white scars in both eyes. There were no complications or recurrence of the disease. Conclusion FBA could be related to several etiologies, vaccinations and viral infections should be considered. 6 , 7 , 8 Interestingly, on the day of presentation our patient had mild common cold symptoms which could be the underlying cause of FBA. However, the fact that the patient’s medical history and laboratory workup were unremarkable. In addition, the close timing of the vaccination event to the disease progression suggested that the pentavalent vaccination was the most likely etiology of the acute idiopathic frosted branch angiitis. Oral Prednisolone and Acyclovir had facilitated the resolution of anatomical and functional abnormalities in less than a month without any complications or recurrence of the disease. Abbreviations FBA Frosted Branch Angiitis CMV Cytomegalovirus AIDS Acquired Immunodeficiency Syndrome HSV Herpes Simplex Virus VZV Varicella-Zoster Virus EBV Epstein-Barr Virus FFA Fundus Fluoresceine Angiography PCR Polymerase Chain Reaction HIV Human Immunodeficiency Virus PPD Purified Protein Derivative HLA Human Leukocyte Antigen C-ANCA Cytoplasmic Antineutrophil Cytoplasmic Antibodies P-ANCA Perinuclear Antineutrophil Cytoplasmic Antibodies MRI Magnetic Resonance Imaging ESR Erythrocyte Sedimentation Rate ERG Electroretinogram VEP Visual Evoked Potential mMRNA-1273 Messenger RNA-1273 COVID-19 Vaccine BNT162b2 Pfizer-BioNTech COVID-19 Vaccine VA Visual Acuity HBV Hepatitis B Virus. Declarations Ethics approval Not applicable (in out institution no need for IRB approval in case reports). Consent to participate Informed written consent was obtained from the parents of the patient for publication of the case details and images. Availability of data and material The data of this case report are included within the manuscript. Further data can be provided upon request. Competing interests The authors declare that they have no competing interests. Funding The authors declare that no funding was received for this case report. Authors’ contributions Dr.Mohammed Aljasir: was responsible for the acquisition of clinical data, analysis, and interpretation of the patient’s condition. Also, assisted in writing and editing the manuscript. Dr.Dhoha Alhamad: contributed to the conception, design, and supervision of the case report, as well as the diagnosis and management of the patient. Also participated in drafting and revising the manuscript. Dr.Shahad Alsubhi: assisted with the data gathering and contributed to writing and reviewing the manuscript. Also, involved in the follow-up care of the patient. Dr.Assaf Almalki: provided critical review and revision of the manuscript, contributed to the interpretation of the clinical data, and helped finalize the manuscript for submission. All authors approved the final manuscript. Acknowledgments We would like to thank the pediatric and ophthalmology teams at Dhahran Eye Specialist Hospital for their contributions to the care of this patient. References Bagheri N, Mehta S (2015) Acute vision loss. Prim Care 42(3):347–361 Gurnani B, Balamurugan S, Kanakath A, Kaur K, Gupta A, Chaudhary S (2023) First clinical case series of frosted branch angiitis: a diagnostic algorithm is suggested. Clin Case Rep 11(9):e7778. 10.1002/ccr3.7778 Walker S, Iguchi A, Jones N (2004) Frosted branch angiitis: a review. Eye 18:527–533. 10.1038/sj.eye.6700712 Watanabe YO, Takeda NO, Adachi-Usami EM (1987) A case of frosted branch angiitis. Br J Ophthalmol 71(7):553–558 Taban M, Sears JE, Crouch E, Schachat AP, Traboulsi EI (2007) Acute idiopathic frosted branch angiitis. J AAPOS 11(3):286–287 Collister K, Dahr SS (2022) Frosted branch angiitis after smallpox vaccination. Am J Ophthalmol Case Rep 27:101622. 10.1016/j.ajoc.2022.101622 Kitaoka M, Ohnishi T, Sugaya S, Yokota H, Nagaoka T, Yamagami S (2023) A case of bilateral frosted branch angiitis after mRNA COVID-19 vaccination. Case Rep Ophthalmol 14(1):e295–e300. 10.1159/000530794 Haas AM, Stattin M, Barisani-Asenbauer T, Krepler K, Ansari-Shahrezaei S (2023) Frosted branch angiitis after booster vaccination with BNT162b2. J Fr Ophtalmol 46(7):e1–e3. 10.1016/j.jfo.2022.12.023 Ito Y, Nakano M, Kyu N, Takeuchi M (1976) Frosted branch angiitis in a child. Rinsho Ganka 30:797–803 United Arab Emirates Children's health [Internet]. https://u.ae/en/information-and-services/health-and-fitness/childrens-health Benage M, Fraunfelder FW (2016 Jan-Feb) Vaccine-associated uveitis. 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Doc Ophthalmol 97:135–142 Garbrecht JL, Powell ZR, McClard CK, Noori J (2024) Frosted branch angiitis in a patient with systemic juvenile idiopathic arthritis: a case report. BMC Ophthalmol 24(1):106 Brêtas CO, Novelli A, Silva TG, Zanandrea LI, Saraiva PG, Vieira MM, Saraiva FP (2021) Bilateral frosted branch angiitis in an initial case of systemic lupus erythematosus. Arq Bras Oftalmol 84(5):499–502 Alexander JL, Miller M (2015) A case of frosted branch angiitis in an immunocompromised child. J Am Assoc Pediatr Ophthalmol Strabismus 19(1):75–76 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 26 Feb, 2025 Read the published version in Journal of Ophthalmic Inflammation and Infection → Version 1 posted Editorial decision: Revision requested 02 Dec, 2024 Reviews received at journal 29 Nov, 2024 Reviews received at journal 29 Nov, 2024 Reviewers agreed at journal 28 Nov, 2024 Reviewers agreed at journal 27 Nov, 2024 Reviewers agreed at journal 24 Nov, 2024 Reviewers agreed at journal 24 Nov, 2024 Reviewers agreed at journal 23 Nov, 2024 Reviewers agreed at journal 22 Nov, 2024 Reviewers invited by journal 22 Nov, 2024 Editor assigned by journal 13 Nov, 2024 Submission checks completed at journal 13 Nov, 2024 First submitted to journal 12 Nov, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5440098","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":385097330,"identity":"f5db5e52-a97a-4f23-b3e6-c1edd165b643","order_by":0,"name":"Mohammed Falah Aljasir","email":"","orcid":"","institution":"Dhahran Eye Specialist Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mohammed","middleName":"Falah","lastName":"Aljasir","suffix":""},{"id":385097332,"identity":"f5eb878c-597d-4190-9ca9-35635b0bcc9e","order_by":1,"name":"Dhoha Mohammed Alhamad","email":"","orcid":"","institution":"Dhahran Eye Specialist 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displayed diffuse vascular leakage with peripheral capillary drop out.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-5440098/v1/7913f4878ca36ec48fe0bd92.png"},{"id":77622474,"identity":"35110919-7ee0-462b-a13d-75862eceec8b","added_by":"auto","created_at":"2025-03-03 16:07:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1298608,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5440098/v1/d60ac12b-0723-470d-a6ce-611c7debbfec.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Sudden Bilateral Vision Loss: A Case Report of Frosted Branch Angiitis Following Pentavalent Vaccination in a 2-Year-Old Boy","fulltext":[{"header":"Introduction/ Background","content":"\u003cp\u003eSudden visual disability in children could be an uncommon but serious and disturbing condition that requires prompt evaluation and intervention. The causes of bilateral vision loss are diverse, ranging from traumatic injuries and infectious diseases to neurovascular events and psychiatric conditions.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Frosted branch angiitis (FBA) is an uncommon pan-uveitic disease characterized by vasculitis affecting the entire retina. While it typically presents bilaterally, unilateral cases do not rule out the diagnosis. The etiology of FBA is varied and may be idiopathic, traumatic, infectious, or related to other factors. Infectious agents associated with FBA include cytomegalovirus (CMV), acquired immunodeficiency syndrome (AIDS), herpes simplex virus (HSV), varicella-zoster virus (VZV), Epstein-Barr virus (EBV), influenza type A, tuberculosis, toxoplasmosis, glomerulonephritis, and Streptococcus. Additionally, autoimmune disorders such as Beh\u0026ccedil;et's disease, systemic lupus erythematosus, antiphospholipid syndrome, Crohn's disease, and Wegener's granulomatosis may also contribute, along with malignancies like large cell lymphoma, acute lymphoblastic leukemia, and Hodgkin's lymphoma.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Therefore, prompt attention is crucial for identifying the specific etiology.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e It has been observed that most cases occur in individuals aged 2 to 42.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e FBA is characterized by vascular inflammation, retinal oedema, vision loss, and significant retinal vascular sheathing of both arterioles and venules.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Fundus examination reveals the inflamed retinal vessels, which resemble a distinctive appearance as frosted branches of a tree.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e This case report describes the first case of idiopathic FBA in a 2-year-old child following pentavalent vaccination.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 2-year-old Emirati boy, heterozygous twin A, medically free, full-term presented to the emergency department at Dhahran Eye Specialist Hospital in the Kingdom of Saudi Arabia with sudden painless vision loss in both eyes for one day. The patient\u0026rsquo;s mother noticed that the child could not walk down the stairs, was looking into plank, and was not interested in the television, which she believed was due to the bilateral sudden vision loss. Ten days prior to the presentation, the child received the pentavalent vaccination in the United Arab Emirates. The patient had no significant past medical history other than one episode of febrile seizure six months ago. The prenatal and natal histories were unremarkable. Review of systems was negative except for common cold symptoms including runny nose and diarrhea, which had been progressing over the past five days, associated with mild fever that lasted for one day only. The mother denied any history of trauma, loss of consciousness, skin rash, mouth ulcers, or joint pain.\u003c/p\u003e \u003cp\u003eDetailed ophthalmic examination showed that the child could not fix or follow an object. The pupils were bilaterally dilated and non-reactive. Anterior segment examination revealed\u0026thinsp;+\u0026thinsp;3 pigmented cells in the anterior chamber in both eyes. Dilated fundoscopy showed hazy vitreous, hyperemic discs, and extensive vascular sheathing in all quadrants in both eyes. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) Fundus fluorescein angiography (FFA) demonstrated diffuse vascular leakage, including optic disc leakage (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), as well as peripheral capillary dropout (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Polymerase chain reaction (PCR) analysis and culture of aqueous fluid of VZV, HSV, and CMV were normal. Furthermore, thorough blood investigations including complete blood count, liver function tests, renal function tests, blood PCR of VZV, HSV and CMV, Syphilis, Human Immunodeficiency Virus (HIV), Toxoplasma latex, Purified Protein Derivative (PPD), Human Leukocyte Antigen (HLA) B27, HLA B51, Anti-Cardiolipin (IgG, IgM), Cytoplasmic Antineutrophil Cytoplasmic Antibodies (C-ANCA), Perinuclear Antineutrophil Cytoplasmic Antibodies (P-ANCA), rheumatoid factor, chest x-ray, and brain Magnetic Resonance Imaging (MRI) were done, all of them were within normal, except high erythrocyte sedimentation rate (ESR) with a level of 26 mm/1h. A comprehensive evaluation with full systemic examination was conducted by a pediatrician. It was inconclusive and the patient was labeled as a case of idiopathic FBA. As a result, oral Prednisolone tapering of 2 mg/kg/day and Acyclovir 200 mg five times a day were prescribed over one month.\u003c/p\u003e \u003cp\u003eClose follow-up was started with plans for tapering therapy as the patient improved. Two weeks after starting the treatment, the patient's vision progressed to the ability to focus and follow with both eyes. The retinal findings showed almost complete resolution of the vasculitis. One month later, a fundus examination showed complete resolution of vasculitis in both eyes. Over one year of follow-up, there was no recurrence of vasculitis; however, small multifocal white scars were observed and remained present in both eyes. Electroretinogram (ERG) suggested dysfunction of the macular-visual pathway. Visual evoked potential (VEP) was done and showed a normal response. The patient was evaluated by a pediatric rheumatologist and immunologist who ruled out underlying systemic diseases.\u003c/p\u003e"},{"header":"Discussions","content":"\u003cp\u003eWe present a unique case of a 2-year-old child with idiopathic FBA following the pentavalent vaccination. FBA is a rare and unique type of uveitis associated with retinal vasculitis resembling the distinctive appearance of frosted branches of a tree.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e The predominant reported cases were of young and healthy patients, with a peak incidence in children and third decade of life.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Most of FBA patients presented with bilateral subacute vision loss associated with floaters and photopsia.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e As described previously, the etiologies of FBA are variable, it could be idiopathic, traumatic, infective, or post-vaccination. There were several reported cases of FBA after receiving vaccination such as [small-pox, mMRNA-1273 COVID-19, booster of BNT162b2 against SARS-CoV-2, and triple vaccine (diphtheria, pertussis, and tetanus)], but none of them were due to the Pentavalent vaccination.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn the United Arab Emirates, the pentavalent vaccination is a combined vaccine against five killer diseases: diphtheria, pertussis, tetanus, haemophilus influenzae type B, and hepatitis B.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e In 1967 a case was reported of a 6-year-old Japanese boy who had bilateral FBA after receiving the triple vaccination of diphtheria, pertussis, and tetanus. He presented initially with visual acuity (VA) of hand motion and counting fingers in the right and left eye, respectively. Five months after administration of steroids and isoniazid, the VA improved to 6/60 and 6/12 in the right and left eye, respectively.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Similarly, our patient presented with signs and symptoms of FBA shortly after the pentavalent vaccine. The patient initially was unable to fix or follow an object. Two weeks after receiving a tapering dose of oral Prednisolone and Acyclovir, the patient's vision progressed to the ability to focus and follow with both eyes. Other subtypes of the pentavalent vaccine, mainly the hepatitis B virus (HBV) vaccine, are associated with other types of ocular uveitis.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Uveitic diseases post HBV vaccine include acute posterior multifocal placoid pigment epitheliopathy, multiple evanescent white dot syndrome, Vogt\u0026ndash;Koyanagi\u0026ndash;Harada syndrome, paracentral acute middle maculopathy, and posterior uveitis.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e HBV vaccination has also been reported to be associated with optic neuritis.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Administration of combined vaccines of diphtheria, tetanus, pertussis, and inactivated poliovirus, has been shown to be associated with optic neuritis.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOther etiologies of FBA in the pediatric population include infectious diseases like upper respiratory tract infection, CMV, VZV, pneumonia, COVID-19, EBV, toxoplasmosis, mumps, and HIV.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e Many cases remain due to an unknown etiology.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e Some cases due to autoimmune diseases like systemic juvenile idiopathic arthritis, SLE, and Behcet disease.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e A couple of cases presented with headache only without a known specific etiology. A handful of cases presented with fever only as the predominant symptom. In addition, one case was associated with fever and sepsis and another child had fever and rash only.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Finally, a single case of a child with Langerhans cell histiocytosis on clofarabine.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e As a result, many differential diagnoses were considered. However, our patient\u0026rsquo;s laboratory tests ruled out any association with syphilitic, herpetic, or tubercular infection. However, COVID-19 PCR was not obtained. The child had no other systemic or ophthalmic signs or symptoms that suggested other etiology. Leukemia or lymphoma were ruled out since there was no history or laboratory findings to suggest such diseases.\u003c/p\u003e \u003cp\u003eTreatment of FBA varies depending on the etiology. Infectious causes are treated with antimicrobial therapy, while inflammatory etiologies are resolved with anti-inflammatory agents. Most of FBA patients treated with systemic steroids showed rapid resolution of symptoms with good visual recovery. Acyclovir has been given in a minority of cases.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e The management of the four reported cases of FBA secondary to vaccination included: systemic steroids for one patient; a combination of systemic steroids and antimicrobial therapy (isoniazid) or antiviral therapy (acyclovir) for two patients; and systemic steroids followed by vitrectomy for the last patient, who had an uneventful recurrent disease.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e In our patient, the signs and symptoms of the common cold and the high ESR level suggested a potential of viral infection. Thus, oral Prednisolone and Acyclovir were given to prevent further progression of the retinal vasculitis.\u003c/p\u003e \u003cp\u003eThe prognosis of FBA has not always been promising with recovery time varying from one case to another. Regaining good visual outcomes ranged from less than a month in the majority of the cases, while in only a minority of cases, the recovery time was longer. Complications secondary to FBA include macular scarring, retinal vein or artery occlusion, macular epiretinal membrane formation, diffuse retinal fibrosis, retinal tear formation, vitreous hemorrhage, optic disc atrophy, and peripheral atrophic retinal lesions.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Our patient showed progressive improvement within two weeks. Ended with complete resolution of vasculitis in less than one month with only remnant of small multifocal white scars in both eyes. There were no complications or recurrence of the disease.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFBA could be related to several etiologies, vaccinations and viral infections should be considered.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Interestingly, on the day of presentation our patient had mild common cold symptoms which could be the underlying cause of FBA. However, the fact that the patient\u0026rsquo;s medical history and laboratory workup were unremarkable. In addition, the close timing of the vaccination event to the disease progression suggested that the pentavalent vaccination was the most likely etiology of the acute idiopathic frosted branch angiitis. Oral Prednisolone and Acyclovir had facilitated the resolution of anatomical and functional abnormalities in less than a month without any complications or recurrence of the disease.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFBA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFrosted Branch Angiitis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCMV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCytomegalovirus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAIDS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAcquired Immunodeficiency Syndrome\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHSV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHerpes Simplex Virus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVZV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVaricella-Zoster Virus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEBV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEpstein-Barr Virus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFFA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFundus Fluoresceine Angiography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePCR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePolymerase Chain Reaction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHIV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHuman Immunodeficiency Virus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePPD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePurified Protein Derivative\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHLA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHuman Leukocyte Antigen\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eC-ANCA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCytoplasmic Antineutrophil Cytoplasmic Antibodies\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eP-ANCA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePerinuclear Antineutrophil Cytoplasmic Antibodies\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMRI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMagnetic Resonance Imaging\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eESR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eErythrocyte Sedimentation Rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eERG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eElectroretinogram\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVEP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVisual Evoked Potential\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003emMRNA-1273\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMessenger RNA-1273 COVID-19 Vaccine\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBNT162b2\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePfizer-BioNTech COVID-19 Vaccine\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVisual Acuity\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHBV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHepatitis B Virus.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable (in out institution no need for IRB approval in case reports).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed written consent was obtained from the parents of the patient for publication of the case details and images.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data of this case report are included within the manuscript. Further data can be provided upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funding was received for this case report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr.Mohammed Aljasir:\u003c/strong\u003e was responsible for the acquisition of clinical data, analysis, and interpretation of the patient\u0026rsquo;s condition. Also, assisted in writing and editing the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr.Dhoha Alhamad:\u003c/strong\u003e contributed to the conception, design, and supervision of the case report, as well as the diagnosis and management of the patient. Also participated in drafting and revising the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr.Shahad Alsubhi:\u003c/strong\u003e assisted with the data gathering and contributed to writing and reviewing the manuscript. Also, involved in the follow-up care of the patient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr.Assaf Almalki:\u0026nbsp;\u003c/strong\u003eprovided critical review and revision of the manuscript, contributed to the interpretation of the clinical data, and helped finalize the manuscript for submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAll authors approved the final manuscript.\u003c/strong\u003e\u003c/p\u003e\n\u003ch4\u003eAcknowledgments\u003c/h4\u003e\n\u003cp\u003eWe would like to thank the pediatric and ophthalmology teams at Dhahran Eye Specialist Hospital for their contributions to the care of this patient.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBagheri N, Mehta S (2015) Acute vision loss. Prim Care 42(3):347\u0026ndash;361\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGurnani B, Balamurugan S, Kanakath A, Kaur K, Gupta A, Chaudhary S (2023) First clinical case series of frosted branch angiitis: a diagnostic algorithm is suggested. Clin Case Rep 11(9):e7778. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/ccr3.7778\u003c/span\u003e\u003cspan address=\"10.1002/ccr3.7778\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWalker S, Iguchi A, Jones N (2004) Frosted branch angiitis: a review. 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Doc Ophthalmol 97:135\u0026ndash;142\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarbrecht JL, Powell ZR, McClard CK, Noori J (2024) Frosted branch angiitis in a patient with systemic juvenile idiopathic arthritis: a case report. BMC Ophthalmol 24(1):106\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBr\u0026ecirc;tas CO, Novelli A, Silva TG, Zanandrea LI, Saraiva PG, Vieira MM, Saraiva FP (2021) Bilateral frosted branch angiitis in an initial case of systemic lupus erythematosus. Arq Bras Oftalmol 84(5):499\u0026ndash;502\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlexander JL, Miller M (2015) A case of frosted branch angiitis in an immunocompromised child. J Am Assoc Pediatr Ophthalmol Strabismus 19(1):75\u0026ndash;76\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-ophthalmic-inflammation-and-infection","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"joii","sideBox":"Learn more about [Journal of Ophthalmic Inflammation and Infection](http://joii-journal.springeropen.com)","snPcode":"12348","submissionUrl":"https://submission.nature.com/new-submission/12348/3","title":"Journal of Ophthalmic Inflammation and Infection","twitterHandle":"@SpringerOpen","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Frosted branch angiitis, Uveitis, Bilateral vision loss, Pentavalent vaccination, Viral infection","lastPublishedDoi":"10.21203/rs.3.rs-5440098/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5440098/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eFrosted branch angiitis (FBA) is a rare form of retinal vasculitis that can lead to significant vision loss. This case report presents a unique case of idiopathic FBA in a 2-year-old boy following pentavalent vaccination.\u003c/p\u003e\u003ch2\u003eCase Presentation:\u003c/h2\u003e \u003cp\u003eA previously healthy 2-year-old Emirati boy presented with sudden painless bilateral vision loss for one day. His mother noted difficulty walking downstairs and a lack of interest in visual stimuli. Ten days prior, he received the pentavalent vaccination in the UAE. Ophthalmic examination revealed bilateral dilated pupils, anterior chamber inflammation, and extensive retinal vascular sheathing. Investigations were unremarkable, leading to a diagnosis of idiopathic FBA. The patient was treated with oral Prednisolone and Acyclovir. Within two weeks, the vision improved significantly, with complete resolution of retinal vasculitis observed within one month. Follow-up over one year showed no recurrence, although small white scars remained in both eyes.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis case highlights the potential association between pentavalent vaccination and the onset of idiopathic FBA. Prompt recognition and treatment with systemic steroids can lead to favorable outcomes, emphasizing the importance of monitoring visual symptoms in pediatric patients following vaccination.\u003c/p\u003e","manuscriptTitle":"Sudden Bilateral Vision Loss: A Case Report of Frosted Branch Angiitis Following Pentavalent Vaccination in a 2-Year-Old Boy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-17 10:02:41","doi":"10.21203/rs.3.rs-5440098/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-12-02T10:46:17+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-29T18:41:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-29T13:52:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"175090067935806124542849021217381371887","date":"2024-11-28T17:10:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"224400300085784735095696177925953404208","date":"2024-11-27T17:42:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"289291957612400893023324699336426364663","date":"2024-11-25T03:12:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"332370868868356136352470906591170659427","date":"2024-11-24T13:41:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"174805982500571676357003062307854496727","date":"2024-11-23T05:34:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"14966262825064032889984762340722866940","date":"2024-11-22T13:36:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-22T13:24:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-13T08:43:59+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-13T08:43:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Ophthalmic Inflammation and Infection","date":"2024-11-12T13:40:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-ophthalmic-inflammation-and-infection","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"joii","sideBox":"Learn more about [Journal of Ophthalmic Inflammation and Infection](http://joii-journal.springeropen.com)","snPcode":"12348","submissionUrl":"https://submission.nature.com/new-submission/12348/3","title":"Journal of Ophthalmic Inflammation and Infection","twitterHandle":"@SpringerOpen","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"66017304-c9f8-4daf-bfea-cff360e2d8a4","owner":[],"postedDate":"December 17th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-03-03T16:01:01+00:00","versionOfRecord":{"articleIdentity":"rs-5440098","link":"https://doi.org/10.1186/s12348-025-00455-z","journal":{"identity":"journal-of-ophthalmic-inflammation-and-infection","isVorOnly":false,"title":"Journal of Ophthalmic Inflammation and Infection"},"publishedOn":"2025-02-26 15:57:02","publishedOnDateReadable":"February 26th, 2025"},"versionCreatedAt":"2024-12-17 10:02:41","video":"","vorDoi":"10.1186/s12348-025-00455-z","vorDoiUrl":"https://doi.org/10.1186/s12348-025-00455-z","workflowStages":[]},"version":"v1","identity":"rs-5440098","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5440098","identity":"rs-5440098","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}