Fatal COVID-19 Pneumonia in a ChAdOx1-S-Vaccinated 71-year old male

A 71-year-old man with a history of hypertension received a full dose of the Vaxzevria vaccine (ChAdOx1-S; AstraZeneca) (first dose on 1 April and second dose on 24 June). Three days after the second dose, he reported cough and fever. However, after 8 days (on 2 July), he visited the emergency room of our hospital due to the worsening of symptoms, including fever and dyspnea.
On admission, the patient’s nasopharyngeal/oropharyngeal (NP/OP) swab tested positive with the detection of the Delta variant. On laboratory examination, he showed a lymphocyte count in the lower range (1100/µL; normal value range 800–5000/µL), an elevation of the D-Dimer level (4810 ng/mL; normal value < 250 ng/mL), and a mild elevation of the C-reactive Protein (CRP, 2.12 mg/dL; normal value < 0.5). The other laboratory values were within the normal range. On admission, the Saturation oxygen level (SO2) was at 88% with PO2/FiO2 290.
A chest Computed tomography (CT) performed in the emergency department showed a typical central and peripheral distribution of ground-glass opacity (GGO) COVID-19 pneumonia. The CT-SS score showed a value of 13/20
The serology, performed with an immunoassay (LiaisonXL), confirmed the presence of SARS-CoV-2 S1/S2 IgM associated with SARS-CoV-2 anti-spike IgG (2080 BAU/mL) (<33.80 BAU/mL: Absent) (>33.80 BAU/mL: presence), which was related to the previous vaccination.
Treatment with dexamethasone (6mg once daily with intravenous administration for 10 days) and conventional oxygen therapy was started, together with low molecular weight heparin (LMWE) at 4000 IU (twice daily with a subcutaneous administration for 10 days).
One week later (on 9 July), another chest CT was performed due to the worsening of the patient’s symptoms with SO2 at 76% and PO2/FiO2 190.
The chest CT showed extended pneumonia, with an evolution in a crazy paving pattern and consolidation areas (CT-SS 16/20). The patient died 5 days later.

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REFERENCE

Brogna B, Bignardi E, Brogna C, Capasso C, Gagliardi G, Martino A, Musto LA. COVID-19 Pneumonia in Vaccinated Population: A Six Clinical and Radiological Case Series. Medicina. 2021 Sep;57(9):891.



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