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Reactivation of Epstein-Barr Virus Following COVID-19 Vaccination

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Epstein-Barr virus (EBV) is a common human herpesvirus that infects a majority of adults worldwide, typically transmitted through saliva during childhood. While most EBV infections are asymptomatic or cause mild symptoms, it can lead to conditions such as infectious mononucleosis (IM) in adolescents and young adults. Here we present two cases suggesting a potential link between EBV reactivation and COVID-19 vaccination.  Case 1 : EBV-Associated Lymphoproliferative Disorder: A 79-year-old male presented with fever, pancytopenia, elevated liver enzyme levels, and other alarming laboratory findings two weeks after receiving the first dose of the BNT162b2 mRNA COVID-19 vaccine. Further investigations revealed EBV viremia localized in natural killer (NK) cells, suggesting a diagnosis of EBV-NK-LPD. Despite aggressive treatment attempts, the patient's condition worsened, and he succumbed to the disease two months later. Case 2 : Cutaneous Manifestations and EBV Reactivation: A 24-year-ol

Parsonage-Turner syndrome as a side effect of booster vaccination

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A 50-year-old man visited a primary care clinic with persistent right arm pain and weakness lasting for 9 weeks. These symptoms began 5 days after receiving a mRNA COVID-19 booster vaccination in his right deltoid. The patient experienced a moderate-to-severe ache at the injection site, radiating to his neck. Over time, he developed progressive weakness in his right shoulder and elbow, along with occasional hand paresthesia.  Despite reporting his symptoms to Malaysian equivalent of VAERS database, the patient sought medical attention only after 9 weeks when his symptoms worsened to the point where he needed assistance with daily activities. He had no other symptoms or relevant medical history, except for completing two doses of an inactivated COVID-19 vaccine 7 months prior. Physical examination revealed muscle wasting in the affected areas without skin changes or tenderness. Neurological evaluations, including nerve conduction studies and electromyography, indicated axonal loss rathe

Update on COVID-19

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Nobody is counting vaccine doses anymore. But COVID-19 is still here, remaining among the top five leading cause of death for older and immunocompromised individuals.  The national public health emergency in the US is set to end on May 11, 2023, with the last states to end statewide emergency orders being New Mexico on March 31 and Rhode Island on April 10, followed by Texas and Connecticut. However, recent events such as the CDC's April 24-27 Epidemic Intelligence Service conference in Atlanta have shown that the virus is still spreading. At least 35 people who attended the conference tested positive for COVID-19, as confirmed by spokesperson  Kristen Nordlund .  According to CDC, Atlanta has a low COVID-19 community level, along with nearly the rest of the U.S. In February,  Dr Deepti Gurdasani   reported her breakthrough case, despite six COVID-19 vaccine doses. Are these repeated doses even helping? There is some evidence they might be helping solid transplant recipients. One s

A New Onset of Ulcerative Colitis post-2nd-breakthrough-COVID-19

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A 21-year-old non-smoking Caucasian male with a history of acute pancreatitis but no other medical issues or family history had two doses of the BNT162b2 mRNA COVID-19 vaccine.  Four months after the second dose he had his first episode of COVID-19. Although not hypoxic, he felt pretty unwell for a week, with a severe cough, fever, generalized body ache, headache, and loss of taste. He received the third dose of the vaccine two months after recovering from COVID. Nine months after the third dose, he had the second episode of COVID-19, during which he was mildly unwell for three days, recovered, and did not require any anti-viral medication or antibiotics. One week post the second episode of COVID-19, he developed diarrhea and abdominal pain. It then progressed to bloody diarrhea. Ulcerative colitis was diagnosed based on his clinical symptoms, biopsy changes, and the exclusion of other causes.  There are ten published case reports about the newly diagnosed ulcerative colitis associate

Acute disseminated encephalomyelitis

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The frequency of CNS neuroinflammatory events reported in the literature after both SARS-CoV-2 infection and COVID-19 vaccination is still largely unknown. While these conditions can occur spontaneously, they have also been reported following vaccinations, including those for influenza, hepatitis B, human papillomavirus, and COVID-19. Viruses and their vaccines  may unmask   CNS neuroinflammatory conditions.   A 47-year-old man with a history of psoriasis and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection presented with 3 months of subacute lower extremity weakness, erectile dysfunction, and gait instability with falls. His symptoms started 2 weeks after receiving the second of his 2-shot primary mRNA vaccine series for coronavirus disease 2019 (COVID-19) vaccination, which he received 3 months after a mild case of COVID-19. He had no other relevant medical or family history and no recent travel. After evaluation by a urologist, he was prescribed a course of ce

Pulmonary manifestations of vaccination

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A previously healthy 46-year-old woman who never had COVID-19, developed pleuritic chest pain on the tenth day after receiving the third dose of BNT162b2 and was subsequently admitted to the emergency department.  Physical examination of the chest revealed a unilateral pleural effusion (accumulation of fluid in the pleural space). During the focused lung ultrasound, a small left pleural effusion was detected by placing the transducer in the left posterior axillary line at the lower part of the chest (zone L3).  She was negative to influenza A, A/H1, A/H3, B; Adenovirus; coronavirus HKU1, NL63, 229E, OC43; parainfluenza virus types 1, 2, 3, 4; RSV; human rhinovirus/enterovirus; human metapneumovirus, Middle East respiratory syncytial coronavirus; SARS-CoV-2 as well as bacteria bordetella pertussis, bordetella parapertussis, Chlamydia pneumoniae, and Mycoplasma pneumoniae. She was also negative to antinuclear antibodies (ANA), anti-double-stranded DNA (anti-dsDNA), rheumatoid factor (RF

Multiorgan Inflammation Following COVID-19 mRNA Vaccination

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A 14-year-old Japanese girl died unexpectedly 2 days after receiving the third dose of the BNT1262b2 mRNA COVID-19 vaccine. Autopsy findings showed congestive edema of the lungs, T-cell lymphocytic and macrophage infiltration in the lungs, pericardium, and myocardium of the left atria and left ventricle, liver, kidneys, stomach, duodenum, bladder, and diaphragm. Since there was no preceding infection, allergy, or drug toxicity exposure, the patient was diagnosed with post-vaccination pneumonia, myopericarditis, hepatitis, nephritis, gastroenteritis, cystitis, and myositis. Arrhythmia of atrial origin was assumed as the cause of cardiac failure and death.  Histopathology of the heart (left atrium), lung, liver, kidney, diaphragm, stomach, duodenum, and bladder of the child (Figure) show severe infiltration.  Multisystem inflammatory syndrome is a life-threatening condition associated with elevated inflammatory markers and multiple organ injury. A diagnosis of exclusion, it has been rep