Frosted branch angiitis post COVID vaccine: A presumptive association with Behçet's disease

PurposeTo report a case highlighting the uncommon presentation of Frosted Branch Angiitis (FBA) in Behçet's Disease (BD), notably in a patient who received a COVID vaccine one month prior to the onset of symptoms. We explore the possible role of vaccination in unmasking BD.MethodsA comprehensive evaluation of a 45-year-old patient with FBA post-COVID vaccination was undertaken.ResultsThe patient exhibited characteristic features of FBA, with classic perivascular sheathing, optic disc edema, and retinal ischemia, which manifested one month after receiving the Pfizer/BioNTech COVID vaccine. Despite a history of recurrent oral aphthosis, systemic workup for autoimmune conditions was unremarkable. Diagnosis of presumptive Behçet's Disease was made based on clinical criteria. Treatment with intravenous methylprednisolone and infliximabn (5 mg/kg) led to complete resolution of ocular symptoms and retinal signs.ConclusionFBA is an uncommon presentation of BD. This case also serves as a stark reminder of the potential consequences of vaccination on immune-mediated diseases. However, the correlation between FBA onset, COVID vaccination, and Behçet's Disease diagnosis necessitates cautious interpretation. Successful use of methylprednisolone and infliximab in achieving resolution of visual symptoms highlights potential therapeutic considerations in similar cases.