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Showing posts from September, 2022

Acute vaccine-induced-pericarditis after COVID-induced myocarditis

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49-year-old woman was diagnosed with myocarditis and pulmonary embolism due to a COVID-19 complication, which led to heart failure with reduced ejection fraction. A month later she received the first dose of  the Pfizer–BioNTech COVID-19 vaccine with no notable side effects. 12 days after her second dose, however, she  presented to a hospital with chest pain, nausea and vomiting. The vital signs included a heart rate of 90 beats per minute and blood pressure of 100/80 mmHg. Pulmonary sounds were absent on the right lung base and there were signs of poor perfusions, such as capillary refill time (CRT) longer than 5 seconds. The initial electrocardiogram showed sinus rhythm, left bundle branch block and left axis deviation.  A computed tomography (CT) angiography ​(showed pleural effusion, larger in the right hemithorax.  Based on the patient’s medical record, this clinical presentation was interpreted as acute decompensated heart failure stage C (“cold and wet") and later with pe

Total hair loss after COVID-19 vaccination

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  A 23-year-old woman presented to the dermatology clinic with complaint of local hair loss on her scalp a week after receiving the first dose of Oxford/AstraZeneca COVID-19 vaccine (AZD1222) in August 2021. She also reported myalgia following the vaccination, which was relieved by acetaminophen. She had no past medical or family history of alopecia areata (AA) and had not received any medications. A positive pull test demonstrated oval-shaped patchy hair loss with defined borders and no scarring or scaling.   Treatment with betamethasone cream 0.1% and pimecrolimus cream 1% started immediately, but after 3 weeks, the patient returned with total hair loss on the scalp and eyebrows.  A diagnosis of alopecia totalis was made for her based on her history and physical characteristics, and treatment with systemic corticosteroid was initiated (oral prednisolone, 300 mg monthly, for 3 months).  Many more cases of males and females between the ages of 15 and 80 losing hair after COVID-19 vacc

Ipsilateral Radial Neuropathy after COVID-19 Vaccination in a 21-year-old man

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Healthy 21-year-old male experienced mild pain/tenderness in the arm after receiving the first dose of BNT162b2 vaccine. It resolved in ~3 days. Later he received the second dose of the same vaccine in the deltoid area of his left arm. He gradually noticed a severe burning sensation and weakness in that arm. Half a day later his hand began to hang down at the wrist ("wrist drop").  On neurological examination two days after vaccination, his wrist and finger drop on the left side were near paralysis (MRC grade 1-2 on the scale of 1-5 of muscle power).  In addition, there was weakness in arm extension and flexion (MRC grade 3-4/5). On sensory examination, there was dysesthesia and numbness over the lateral dorsum of the left hand. Reflexes were hypoactive. Left radial neuropathy with demyelination and axonal injury were suspected. Laboratory findings for vasculitis, autoimmune disorders, malignancy and infectious disease were unremarkable . The patient was diagnosed with ipsil

Quadruple-vaxxed 60-year-old man tests positive for COVID second time in 2 months

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59-year-old male got vaccinated with the first two doses of  Pfizer/BioNTech COVID-19 vaccine in March 2021 . He received the recommended initial (third dose) and 2nd (fourth dose) booster shots following the CDC guidelines.  CDC strengthened its recommendation on the 1st booster shot for individuals who are 18 years and older in the end of November 2021 , if they were 6 months after their initial Pfizer or Moderna series or 2 months after their initial J&J vaccine. Following  FDA’s regulatory action, on March 29 2022, external icon CDC updated its recommendations to allow all people over the age of 50 who received an initial booster dose at least 4 months ago to be eligible for another mRNA booster to increase their protection against severe disease from COVID-19.  external icon , today, CDC is updating its recommendations to allow certain immunocompromised individuals and people over the age of 50 who received an initial booster dose at least 4 months ago to be eligible for anoth

Breakthrough long COVID in a patient with rheumatoid arthritis

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A 37-year-old South Asian woman  with a 7-year history of rheumatoid arthritis (on bi-weekly tocilizumab injections) tested SARS-CoV-2 positive 9 month after receiving her vaccination (JNJ-78436735). She experienced persistent headache and fatigue for >6 weeks after infection and continued to test intermittently antigen+ for 14 weeks post-infection despite no overt exposure to SARS-CoV-2 infected individuals. She lived alone, did not leave her residence without a surgical-grade N95 mask, and never removed the mask in public. She was subsequently prescribed a 5-day course of nirmeltravir/ritonavir 300/100 mg twice daily. Initially, all PASC symptoms resolved, and the patient tested antigen negative 3 weeks after completion of nirmeltravir/ritonavir, but the symptoms and antigen positivity subsequently reappeared at 4 weeks (see figure). Assessment of adaptive immune responses demonstrated that nirmatrelvir/ritonavir and tocilizumab treatment decreased antiviral and autoreactive T cel

Vaccine-induced interstitial lung disease

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Interstitial lung disease is the most common and serious complication of the inflammatory muscle diseases  It can be caused by long-term environmental exposures or autoimmune diseases such as rheumatoid arthritis, but in some cases the causes remain unknown. In a study of  545 patients with  interstitial lung disease (ILD) in Japan,  ~3% of patients  reported that COVID-19 vaccination caused an adverse reaction of worsening respiratory symptoms. F our patients experienced acute exacerbations. Two of them had collagen vascular disease-associated ILD, one had nonspecific interstitial pneumonia, another had unclassifiable idiopathic pneumonia, and none had idiopathic pulmonary fibrosis. In addition to adverse reactions, increased prevalence of non-response to vaccine was observed in patients with autoimmune-systemic-disease-related interstitial lung disease  (p = 0.009) Several other cases were described in medical literature two were so severe  (males in their 60s) they required intuba

COVID-19 vaccine-associated myositis

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A 53-year-old healthy man received the first dose of the ChAdOx1 nCoV-19 vaccine (COVISHIELD) into his left deltoid muscle. He experienced pain in the left upper arm, followed by the right upper arm and bilateral calf muscles (left more than right). The pain gradually increased, restricting his daily activities. On the 11th day of vaccination, he had difficulty walking and moving his left arm. He also reported generalized muscle weakness, more pronounced in the proximal upper and lower limbs than the distal ones. His medical history was unremarkable with no evidence of COVID-19 infection in the past. Serologic testing yielded mildly increased serum creatine kinase (187 U/L, reference range 40–171 U/L) and alanine transaminase (50 U/L, reference range 10–40 U/L) concentrations. Serum bilirubin, aspartate aminotransferase (AST), gamma glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), and C-reactive protein levels were normal. Urine analysis excluded myoglobinuria.  On MRI, edema

Bipolar disorder after COVID-19

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55-year-old male with no previous mental illness background presented with full-blown manic symptoms following a severe course of COVID-19 infections that required admission. The patient presented with behavioral disturbance after a diagnosis of COVID-19. He exhibited symptoms including irritability, verbal and physical aggressiveness, increased goal-directed activity, elated and expansive mood, increased energy, grandiosity and inflated self-esteem, and decreased need for sleep. With the diagnosis of bipolar I disorder, current manic episode, severe, with psychotic feature, and first manic episode due to COVID-19 infection, he was admitted to the psychiatry emergency ward. By day 21, after treatment, he was discharged from the hospital with full improvement.  This case presents an Ethiopian Perspective . Similar cases were described for a 44-year old Polish man with no psychiatric history and another healthy  51-year old Chinese male .  A study of more than 11 million people shows a

Pediatric myocarditis after mRNA COVID-19 vaccination in Japan

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A 12-year-old boy with unremarkable family and personal medical history presented with chest pain after the first dose of BNT162b2 vaccine. One day after vaccination, he developed fever and fatigue, followed by chest pain the next day. At presentation his heart rate was 82 beats/min. Laboratory tests revealed elevated troponin and NT-proBNP. The ECG showed ST elevation in leads I, II, and V3–6 (as shown in the Figure).  Echocardiography revealed a left ventricular ejection fraction of 68%, mild pericardial effusion, and increased epicardial echodensity. A diagnosis of myocarditis after mRNA COVID-19 vaccination was made, and the patient was treated with 30 mg/kg of aspirin and famotidine. On the next day, the chest pain improved, and the troponin I and NT-proBNP levels decreased to 820.4 and 74 pg/mL, respectively. On the fourth day of admission, the chest pain resolved, the troponin I level decreased to 355 pg/mL, ECG was normalized, and cardiac contrast-enhanced magnetic resonance

79-year old woman dies from anaphylaxis after vaccination

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79-year old female, resident of a retirement home in Maple Ridge of British Columbia    with history of  chronic obstructive pulmonary disease, emphysema and diabetes   received a Moderna vaccine. Ten minutes later, she was having a hard time breathing. Soon she was unconscious. A nurse administered two EpiPens – one in a leg, and one in an arm, but they couldn’t save her.  She was gone in 15 minutes.  It had been a severe anaphylactic shock, despite the fact that she had never had an allergic reaction in the past.  Her daughter is  one of the first people in Canada to be compensated for a family member’s death under Canada’s Vaccine Injury Support Program.  The program started in June of 2021. So far it has 774 claims, eight claims have been already approved by the program’s medical review board. REFERENCES https://www.mapleridgenews.com/news/maple-ridge-woman-compensated-for-mothers-death-from-covid-19-vaccine/ https://canadatoday.news/bc/maple-ridge-woman-compensates-for-mothers-dea

Psychosis following COVID-19 vaccination

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A 45-year-old male was extremely reluctant to be vaccinated but was pressured at his workplace. The patient's unusual behavior began within five days of receiving the one-dose Ad26.COV2.S adenoviral vector vaccine. He became anxious, suspicious, paranoid, disorganized and complained of headaches. No neurological deficits were found upon examination. Two weeks after the COVID-19 vaccination, persecutory delusions and delusions of reference led the patient to suicide attempt by stabbing himself in the abdomen. After abdominal surgery, the patient was admitted to the Clinic of Psychiatry. In addition to paranoid delusions, the psychiatric evaluation revealed intrapsychic tension and low affect modulation. After two weeks of treatment, the patient's condition improved. After 23 days of treatment in the Clinic, he was discharged without psychotic symptoms.    A 41-year-old male patient developed anxiety during the COVID-19 pandemic. Five days after the second dose of t