Development of Optic Neuritis After SARS-CoV-2 mRNA Vaccination: A Report of Five Cases

Abstract

We encountered five cases of optic neuritis that developed within 2 months after SARS-CoV-2 vaccination. Two（cases 1 and 2）had typical anti-myelin oligodendrocyte glycoprotein（MOG）antibody-positive optic neuritis, the first in one eye and the second in both eyes. The third case had atypical bilateral MOG-positive optic neuritis with uveitis. The fourth case had atypical bilateral optic neuritis with periocular inflammation-like findings and marked subarachnoid space enlargement. The fifth case had atypical unilateral MOG-positive optic neuritis. Although it took approximately 2 months from vaccination to active progression, the possibility of an adverse reaction to the SARS-CoV-2 vaccine should be considered due to the timing of vaccination and the onset of optic neuritis. Each of these five cases showed completely different clinical findings. Optic neuritis after SARS-CoV-2 vaccination may have various clinical presentations, ranging from cases with typical optic neuritis to atypical optic neuritis that seems to be caused by a disease other than optic neuritis. That four of the five cases were positive for anti-MOG antibodies is a suggestive finding. Thus, suspecting an association between vaccination and anti-MOG antibody-positive optic neuritis is inevitable, and the pathogenetic mechanism should be investigated.