Exacerbation of COPD after a COVID 19-Booster Vaccine

A 75-year-old African American woman presented to the Emergency Department (ED) complaining of shortness of breath, cough and a drop in her oxygen saturation (SpO2) from her baseline of 95%–88%. 

She received a Pfizer COVID 19 booster vaccine one day before her symptoms began. The patient had received the Johnson & Johnson COVID-19 vaccine 11 months prior without a notable reaction.  She had a history of chronic obstructive pulmonary disease (COPD) but was not on any home oxygen. 

Upon admission the patient had an SpO2 of 82% and a heart rate of 101 beats per minute. Notably, she was afebrile, with a temperature of 36.6 °C. On physical exam the patient was noted to be wheezing and breathing with difficulty. She tested negative for a variety of respiratory viruses including COVID-19. A chest radiograph (x-ray) demonstrated subtle patchy opacifications consistent with a COPD exacerbation, and no consolidations or pleural effusions. A normal cardiac silhouette was also observed.

After treatment, she was slowly weaned off supplemental oxygen over the course of her 5-day hospitalization and sent home.

A 76-year-old male with past medical history significant for lung adenocarcinoma stage IIB on chemotherapy, severe COPD, chronic hypoxic respiratory failure, low grade non-Hodgkin's lymphoma in remission, hypertension, gout, hear failure, that presents with fever 102F, and shortness of breath experienced life-threatening shortness of breath 24 hours after his 2nd dose of mRNA-1273 (Moderna COVID-19 vaccine). Fever and shortness of breath improved with systemic steroids. Patient remained stable on his home dose of oxygen supplementation while inpatient and was successfully discharged to home with prednisone taper. 


Several cases of COPD patients who died shortly after vaccine administration have been also reported. Postvaccination acute hypoxemic respiratory failure (46.3%), septic shock (24.4%), and cardiogenic shock (12.2%) were the most common causes of death.


REFERENCES

Gatenby W, Dominah G, Paudel A, Saleh N. A Chronic Obstructive Pulmonary Disease Exacerbation Following the Administration of a COVID 19-Booster Vaccine: A Case Report. Journal of Community Hospital Internal Medicine Perspectives. 2022;12(5):110-3.

Durdevic M, Arora A, Durdevic D, Stan AC, Naaraayan A. Acute COPD Exacerbation After The Second Dose of COVID-19 Vaccine. Chest. 2021 Oct 1;160(4):A1760.

Kewan T, Flores M, Mushtaq K, Alwakeel M, Burton R, Campbell J, Perry H, Al‐Jaghbeer M, Abi Fadel F. Characteristics and outcomes of adverse events after COVID‐19 vaccination. Journal of the American College of Emergency Physicians Open. 2021 Oct;2(5):e12565.

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