Vaccine-induced interstitial lung disease

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. Four 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 intubation. An 82-year-old woman who developed symmetrical ground-glass opacification with spontaneous pneumomediastinum and pneumothorax after second dose of BNT162b2-mRNA vaccine did not survive. 

A 66-year-old man presented to the emergency department with respiratory failure 13 days after receiving his second dose of the coronavirus disease 2019 (COVID-19) vaccination (BNT162b2). He had developed a fever on the second day after the second vaccination, but it decreased to 37°C without medication. On the fifth day, he had a fever of 39°C, cough and malaise, and his symptoms worsened. On the 13th day, he visited the hospital with marked hypoxemia. The patient was intubated 6 h after admission and started on intravenous methylprednisolone 1000 mg/day with ventilator management. Respiratory failure was markedly improved after steroid administration. Two days later, the patient was successfully extubated. On the fourth day of hospitalization, the steroid dose was reduced to prednisolone 30 mg/day orally. The patient was discharged on the seventh day of hospitalization. After discharge, steroid dose was gradually reduced without any relapse.

A 60-year-old man presented with dyspnea four days after the second dose of COVID-19 vaccine. He had a history of smoking, asthma-chronic obstructive lung disease (COPD) overlap syndrome, hypertension, complete right bundle branch block and mild mitral regurgitation. Imaging revealed extensive ground-glass opacification (see Figure above). His respiratory condition gradually worsened, which required mechanical ventilation. On the 7th day, the patient was extubated and was slowly improving. 


REFERENCES

Sakayori M, Hagiwara E, Baba T, Kitamura H, Sekine A, Ikeda S, Tabata E, Yamada S, Fujimoto K, Ogura T. Incidence of acute exacerbation in patients with interstitial lung disease after COVID-19 vaccination. Journal of Infection and Chemotherapy. 2022 Sep 13.

Taverner JV, Robertson JG. A case of interstitial lung disease following Oxford‐AstraZeneca COVID‐19 vaccination. Internal Medicine Journal. 2022 Jul;52(7):1276.

DeDent AM, Farrand E. Vaccine-induced interstitial lung disease: a rare reaction to COVID-19 vaccination. Thorax. 2022 Jan 1;77(1):9-10.

Ueno T, Ohta T, Sugio Y, Ohno Y, Uehara Y. Severe acute interstitial lung disease after BNT162b2 mRNA COVID-19 vaccination in a patient post HLA-haploidentical hematopoietic stem cell transplantation. Bone Marrow Transplantation. 2022 May;57(5):840-2.

Abraham B, Saeed HM, Pasha SA. Acute respiratory distress syndrome secondary to COVID-19 mRNA vaccine administration in a pregnant woman: A case report. Qatar Medical Journal. 2022 Sep 12;2022(3):40.

Kono A, Yoshioka R, Hawk P, Iwashina K, Inoue D, Suzuki M, Narita C, Haruta K, Miyake A, Yoshida H, Tosaka N. A case of severe interstitial lung disease after COVID-19 vaccination. QJM: An International Journal of Medicine. 2021 Nov;114(11):805-6.

Shimizu T, Watanabe S, Yoneda T, Kinoshita M, Terada N, Kobayashi T, Gohara K, Tsuji T, Nakatsumi H, Tambo Y, Ohkura N. Interstitial pneumonitis after COVID-19 vaccination: A report of three cases. Allergology International. 2022;71(2):251-3.


Matsuzaki S, Kamiya H, Inoshima I, Hirasawa Y, Tago O, Arai M. COVID-19 mRNA vaccine-induced pneumonitis. Internal Medicine. 2022 Jan 1;61(1):81-6.

Park JY, Kim JH, Lee IJ, Kim HI, Park S, Hwang YI, Jang SH, Jung KS. COVID-19 vaccine-related interstitial lung disease: a case study. Thorax. 2022 Jan 1;77(1):102-4.

Yoshifuji A, Ishioka K, Masuzawa Y, Suda S, Murata S, Uwamino Y, Fujino M, Miyahara H, Hasegawa N, Ryuzaki M, Hoshino H. COVID-19 vaccine induced interstitial lung disease. Journal of Infection and Chemotherapy. 2022 Jan 1;28(1):95-8.

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