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Reply to a Letter to the Editor on a Published Manuscript: Bilateral Multifocal Choroiditis following COVID-19 Vaccination

We thank the authors for their interest in our paper and their insightful comments. Auto-immune pathogenesis of the choroiditis was established by the fact that he had very high COVID antibody titres (IgG antibodies as detected by chemoluminescent immune assay (CLIA) for SARS-CoV-2 IgG >20 index; reference range: negative <1 index; positive >/ = 1 index) indicating a strong immune response to vaccine. Associated constitutional symptoms of severe frontal headache, ocular pain, fever and generalized myalgia within 5 days of each dose of Covishield vaccine suggest an auto-immune response triggered by the vaccine. Recurrence of auto-immune events following redosing is known. Patient was investigated for underlying infections causing choroiditis, namely, tuberculosis, syphilis and rickettsia, and these returned negative. We agree that rheological changes may contribute to choroiditis. However, patient’s haemogram was within normal limits. Our patient had unilateral red eye and bilateral choroiditis within a week of the second dose with dramatic response to oral steroids within a few days, which suggests an immune pathogenesis rather than hyperviscosity as the underlying cause for the choroiditis. Declaration of interest