Showing posts from November, 2022

ANCA-associated vasculitis

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a  rare disease with an annual incidence of approximately 20 per million population in Europe and North America. The aetiopathogenesis is complex and is mainly driven by the gene environment interactions. Genes associated with this condition include HLA-DQ (variations in which have been linked to asymptomatic COVID), IL-5 and GPA33. COVID-19 heralds a poor prognosis in those with preexisting AAV with over 50% patients having severe disease. Loss of smell is observed in AAV population more frequently (~50%) than in others (~35%).  70-year-old Chinese woman presented  with poor appetite and nausea 4 hours after receiving the first dose of CoronaVac vaccine. These symptoms progressively worsened, followed by fatigue and foamy urine 10 days later. Her medical history included hypertension, hyperlipidemia, and kidney stones. She had penicillin allergy and no family history of ANCA-associated vasculitis.  Treatment h

Sudden onset of vitiligo after COVID‐19 vaccine

A 33‐year‐old healthy female presented with a 45‐days history of milky‐white well‐demarcated, oval and liner‐shaped macules on her trunk, neck and back which had appeared 1 week after receiving her first dose of Pfizer‐BioNTech COVID‐19 vaccine. The second dose of vaccine was injected 1 months later without the appearance of new macules.  She had family history of vitiligo (father) but never suffered from it before.  Similar case was observed for a 13-year old girl with family history (father and paternal uncle).   Similar cases were reported 1 week after the first dose of Pfizer–BioNTech COVID‐19 vaccine in a 58‐year‐old man without family history for vitiligo suffering from ulcerative colitis 3.  A 69-year-old woman without personal/familiar history of vitiligo and other autoimmune diseases developed vitiligo several days after her first dose of Moderna (mRNA‐1273) COVID‐19 vaccine.  The macules progressed in size, number and degree of hypopigmentation after the booster dose. A

Rapidly Progressive Dementia Following COVID-19 Vaccination

  A previously healthy woman in her 60s had mild fever and uneventful course after the 1st dose of  ChAdOx1 nCoV-19 vaccine, but  developed behavioral problems and refusal to take food, one day after receiving the second dose of ChAdOx1 nCoV-19 vaccination (dose interval 84 days). Her condition progressed rapidly with onset of confusion, forgetfulness, and hallucinations within the next 5 days. Over the next two days, the patient developed difficulty in walking and echolalia. She was prescribed amantadine, trihexyphenidyl and clonazepam by a local practitioner but she showed further deterioration in the form of irritability, incoherent speech, aggravated forgetfulness, auditory and visual hallucinations, abnormal movements of limbs, and jaw and neck dystonia. The patient had a serum anti-Spike protein IgG titer of 1891.5 AU/mL (non-reactive<50 AU/mL) at 37 days post-second dose. An initial magnetic resonance imaging (MRI) of the brain had revealed FLAIR hyperintensity in bilateral c

Genetic predisposition to long-COVID and long-COVID–like symptoms due to COVID-19 vaccines: a case of a 35-year-old woman

A 35-year-old woman with history of cardiovascular disease presented with shortness of breath, lightheadedness, fatigue, chest pain, and premature ventricular contractions (pericarditis) 3 weeks after her second COVID-19 vaccine.  Some long-COVID–like symptoms  subsided following treatment except for chest pain and fatigue .  3 weeks later, the patient tested positive for SARS-CoV-2 .  Shortly after infection, the patient presented again with chest pain when moving or breathing, joint pain, and dermatitis, symptoms that persisted for 6 months.   Antinuclear antibody (ANA) Immunofluorescence assay screening was positive for autoimmune antibodies. This is in line with our findings about higher probability of breakthrough infections among those with long-COVID-like reactions to COVID-19 vaccines and genetic origins of some adverse reactions.  The patient has a family history of diabetes, high blood pressure, and cardiac cirrhosis. Genetic analyses exploring 100 genes for CVD and diabete

Hemophagocytic Lymphohistiocytosis after Vaccination

  An 85-year-old Japanese woman with chronic renal failure and hypertension  developed malaise, vomiting, and persistent high fever (up to 39.7°C) on the 12 th  day after receiving the second dose of the  BNT162b2  vaccine. Initial evaluation revealed neutropenia.  Further tests showed hyperferritinemia (serum ferritin 2284.4 μg/L). Bone marrow examination revealed haemophagocytosis. A provisional diagnosis of HLH associated with the Comirnaty ®  vaccination was made based on the HLH-2004 diagnostic criteria.  The patient was treated with granulocyte colony-stimulating factor and 500 mg methylprednisolone. A significant improvement was observed; the abnormal laboratory results resolved gradually, and the patient was discharged. READ MORE REFERENCE Shimada Y, Nagaba Y, Okawa H, Ehara K, Okada S, Yokomori H. A case of hemophagocytic lymphohistiocytosis after BNT162b2 COVID-19 (Comirnaty®) vaccination. Medicine (Baltimore). 2022 Oct 28;101(43):e31304. doi: 10.1097/MD.0000000000031304. PM