Long COVID and Adverse Effects of Vaccination in a 31-year-old woman with incontinentia pigmenti

Despite multiple publications, feverishly sprouting Long Covid clinics and $1.15 billion in federal funding for the National Institutes of Health to support research, there still remains a lack of comprehensive understanding and no guidelines regarding the management of this lingering condition.

Patients with certain genetics - like inborn errors of the TLR3- and IRF7-dependent production and amplification of type I IFNs - are prone to both life-threatening COVID-19 pneumonia and adverse reactions to some vaccines - like yellow fever virus live attenuated vaccine, due to the production of autoantibodies. 

This case report describes COVID-19 infection and vaccination adverse effects in a 31-year old woman with genetic condition Incontinentia pigmenti (IP) .

This Canadian (Caucasian) woman had a severe case of COVID-19 and was hospitalized for oxygen therapy, intravenous antibiotics, and corticosteroids. 


On Day 1, she had fatigue and a sore throat. A nasopharyngeal swab on the same day tested positive for SARS-CoV-2 on polymerase chain reaction (PCR).

In Day 14, she consulted a COVID-19 clinic, complaining of fever (40.5°C), chills, myalgia, asthenia, headaches, anosmia, dysgeusia, pharyngitis, dry cough, dyspnea at speech, anorexia, dizziness, diarrhea, and facial rash. She was hospitalized and received oxygen supplementation by nasal cannula, intravenous corticotherapy, and antibiotics. She did not need intubation. She was diagnosed with bacterial pneumonia as per chest X-ray and discharged 4 days later with moxifloxacin for 7 days.

In Day 29, she consulted for relapsing cough and dyspnea. The chest X-ray showed an overall decrease in alveolar consolidation but persistence in the pulmonary bases and accentuation in the left inferior lobe. Doxycycline was started for 7 days, as well as a budesonide/formoterol inhalator.

In Day 50, she was diagnosed with acute otitis media. She complained of earache, hearing loss, sore throat, nasal congestion, rhinorrhea, headache, myalgia, and dizziness. She was subfebrile. The cough had improved somewhat. She received intranasal corticosteroids and a prescription for cefprozil antibiotic, from which she later developed a rash. Intramuscular ceftriaxone was planned but levofloxacin was tried first, given the rhinosinusitis symptoms.

In Day 70, symptoms persisted but without fever. Refractory rhinosinusitis was suspected; a non-steroidal anti-inflammatory drug was prescribed while awaiting sinus imaging.

In Day 86, a computed tomography (CT) angiography was ordered for coughing and slowly worsening dyspnea. The CT angiography showed alveolitis but no pulmonary embolism. The patient was referred to a pulmonologist. A new course of corticotherapy and antibiotics helped relieve infectious (suspected bacterial superinfection) and inflammatory symptoms.

In Month 3, symptoms persisted and now included cognitive deficits. Unable to focus attention, she quit work; academic performance dropped. 

In Month 8, side effects of a first COVID-19 vaccination on 21 April 2021 included 40°C fever and temporary exacerbation of long-haul symptoms (headaches, dizziness, nausea, chills, myalgia, cough, and dyspnea).

In Month 9, the patient was still unable to work, with persistent severe fatigue and multiple symptoms. She is still symptomatic. 

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REFERENCE

Rheault S. Severe COVID-19 and long COVID in a 31-year-old woman with incontinentia pigmenti: A case report. SAGE Open Medical Case Reports. 2021 Nov;9:2050313X211059295.

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