COVID-19 vaccine-related pneumonitis

COVID-19 vaccine-related pneumonitis (CV-P) should be considered in patients with atypical lung infiltration, no specific etiologies, and recent COVID-19 vaccination. 

An article posted ahead of print by the Korean Journal of Internal Medicine describes 11 cases with a median age of 80. 10 individuals survived, but one patient with acute respiratory distress syndrome (ARDS), an 82-year-old-female, died despite appropriate treatment. Her chest CT displayed diffuse alveolar damage (DAD pattern). 

Here are several other cases:

An 83-year-old woman who received the second dose of BNT162b2-mRNA vaccine presented with an organizing pneumonia pattern of CV-P. Chest CT revealed multifocal patchy consolidations, ground-glass opacifications (GGOs), and mild interlobar septal thickening in both lungs (14 days after the second dose). BAL fluid analysis revealed neutrophils (Np) 24%, lymphocytes (Lp) 32%, eosinophils (Eo) 32%, and macrophages (Mq) 12%. All microbiological tests in BAL specimens were negative. Intravenous methylprednisolone was initiated at 24 mg/day, and the patient had a rapid response to treatment.

73-year-old man who received the first dose of ChAdOx1 nCoV-19 vaccine. Chest CT revealed extensive bilateral GGOs with consolidations. There were no abnormal findings in the lung parenchyma on chest CT performed 10 months prior. BAL fluid analysis revealed Np 29%, Lp 32%, Eo 2%, and Mq 37%. The interstitial lesions gradually improved with steroid treatment.

51-year-old woman received the first dose of BNT162b2-mRNA vaccine. 8 days after vaccination, chest CT showed diffuse bilateral GGOs, centrilobular nodules, bronchovascular bundles, and interlobular septal thickening, but no cardiomegaly. Small bilateral pleural effusions were present, but not shown in the current figure. BAL fluid analysis revealed Np 0%, Lp 92%, Eo 7%, and Mq 1%. Methylprednisolone was initiated at 90 mg/day; rapid clinical and radiological improvement was observed.

 An 80-year-old woman was diagnosed with HP following mold exposure 2 years prior. She changed her living accommodations and received corticosteroid therapy for 3 months resulting in complete remission and was relapse-free after discontinuation of steroids. Cough with sputum production developed 7 days after BNT162b2-mRNA vaccination, and chest CT showed recurrence of centrilobular nodules, GGOs, and a mosaic pattern of HP. She improved with steroid treatment.

Acute exacerbation of IPF was observed in an 80-year-old man who received BNT162b2-mRNA vaccine (first dose). He discontinued pirfenidone 1 year before vaccination due to adverse skin reactions and anorexia. Four days after COVID-19 vaccination, chest CT revealed new bilateral GGOs superimposed on reticular opacities and honeycombing with spontaneous pneumothorax. The patient improved with steroid treatment and chest tube management and was discharged with no acute exacerbation thereafter.


REFERENCE

Ji Young Park, Joo-Hee Kim, Sunghoon Park, Yong Il Hwang, Hwan Il Kim, Seung Hun Jang, Ki-Suck Jung, Yong Kyun Kim, Hyun Ah Kim, and In Jae Lee. Clinical characteristics of patients with COVID-19 vaccine-related pneumonitis: a case series and literature review. Korean J Intern Med 2022/08/22 doi: 10.3904/kjim.2022.072

Comments

Post a Comment

Popular posts from this blog

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

Image
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
Read more

COVID in May

Image
Concerns about a potential resurgence of COVID-19 are mounting as summer 2024 approaches.  This is driven by several indicators, including social media posts, healthcare data, and wastewater surveillance across different regions. Our study findings corroborate this trend.  While many forecasters anticipate a surge, others expect a gradual increase through the end of May, and then a decline again around early June. Reports from social media suggest emerging clusters of COVID-19 in Texas, several Canadian provinces, the UK, and on cruises in northern regions such as a Norwegian cruise to Alaska.  Data from Alberta's Respiratory virus dashboard   (total weekly laboratory-confirmed COVID-19 cases) and wastewater surveillance in Calgary indicate an uptick in COVID-19 cases starting April 2024. The most recent statistics from Alberta Health reveal a significant increase in hospitalizations due to COVID-19, with 114 individuals currently hospitalized—an increase of more than 20% over two
Read more

Chronic SARS-CoV-2 Shedding

Image
Chronic viral shedding, a condition where the virus continues to be released from an individual's body long after the initial infection, has been observed in many infectious diseases, including COVID-19.  In such cases, individuals may remain asymptomatic or experience only mild symptoms while the virus persists. It remains detectable in repeated tests over an extended period and can still infect others even in nasal swab is negative (which happens quite often ). This was evident in our study.    Recent research by Conway et al. (2024) highlights the possibility of chronic SARS-CoV-2 infection, extending over several months and potentially years. Other studies have documented prolonged asymptomatic infections and extended viral shedding in moderate to severe beyond hospital discharge. Analysis of sequencing data on UK samples taken between 2 November 2020 and 15 August 2022 lead to estimates that 0.1–0.5% of infections may become persistent with typically rebounding high viral load
Read more