Showing posts from December, 2022

Breakthrough SARS-CoV-2 infection precipitating a stroke in a child

A six-and-a-half-year-old fully vaccinated and previously healthy Asian boy presented to the accident and emergency department with 5-day history of high-grade fever associated with non-projectile vomiting, loose stools, abdominal pain, generalized rashes and conjunctivitis without discharge, reduced oral intake and urine frequency. However, he had no history of cough, joint or limb pain, sore throat or rhinorrhea. He was treated for a suspected bacterial infection with co-amoxiclav and paracetamol then cefixime, ibuprofen and desloratadine. As the illness progressed , he became extremely weak associated with headache and on the day of presentation at the hospital he was irritable, had lost speech with mouth deviation towards the left side. He had no reported convulsions, visual disturbance, difficulty swallowing, drooling, difficulty breathing or incontinence. A week prior to his illness, he was exposed to a relative suffering from COVID-19.  A brain MRI revealed acute ischemic infarc

Pancreatitis after COVID-19 vaccines

A 24-year-old South-Asian female received  er first dose of the Pfizer vaccine  at 30 weeks of gestation. One week later she presented with severe epigastric pain radiating to the back and worsening on lying supine, associated with nausea and vomiting. She was diagnosed with acute pancreatitis with a serum lipase level of 4376 U/L and an ultrasound showing features of pancreatitis. The patient had a spontaneous vaginal delivery, and the baby was shifted to the neonatal intensive care unit in a stable condition. A computed tomography scan postpartum (day 2) demonstrated acute interstitial edematous pancreatitis. The patient was managed conservatively in the intensive care unit and discharged home in a stable condition. A 28-year old previously healthy woman   experienced  abdominal pain three days after the injection of the second dose of the Sinopharm COVID-19 vaccine. She presented at the emergency department but all the tests and imaging were normal and she was discharged with suppo

Post-vaccinal Angina

Besides vaccine-induced myocarditis, there could be other cardiovascular complications, such as post-vaccinal Kounis syndrome (also referred to as allergic angina) or Vasospastic Angina (VSA). The latter form of angina pectoris is characterized by severe pain in the chest (caused by coronary artery spasm, which consists of a sudden occlusive vasoconstriction of a segment of an epicardial artery, resulting in a dramatic reduction of coronary blood flow). It can occur at rest, with transient electrocardiogram modifications and preserved exercise capacity. COVID-19 vaccination may increase coronary artery spasticity.  A 41-year-old male patient was referred for chest pain at rest following mRNA vaccination; he had never experienced chest pain prior to vaccination. He was diagnosed by an acetylcholine (Ach) provocation test that showed multivessel vasospasm. After the initiation of treatment with a calcium channel blocker and nitrate, no further exacerbation of chest pain was observed.  A

Oral manifestations after COVID-19 vaccination

A 38‐year‐old Thai woman developed painful oral lesions lasting over 8 weeks. The lesions appeared 1 week following the administration of the first dose of AZD1222 vaccine. Her extraoral examination was unremarkable. The intraoral examination revealed generalized desquamative epithelium, erythematous areas along the marginal gingivae and alveolar mucosa. Pseudomembranes, and erosions and ulceration on the buccal gingiva subjacent to the maxillary and mandibular teeth, and the right lingual dorsum could be seen. Furthermore, generalized desquamative epithelium of the alveolar mucosa of the anterior mandibular teeth as well as the right mandibular and left maxillary posterior molars extending to the mucobuccal folds were present. Erythematous areas also extended from the lingual gingiva of anterior mandibular teeth onto the floor of mouth. The histopathologic and direct immunofluorescence examination confirmed a diagnosis of pemphigus. After treatment with a potent topical steroid, fluo

Multiple Keratoacanthomas Following COVID-19 Vaccination

K er ato ac anth omas are a type of skin growth that can be found in people of any age or gender but are more common in older individuals. They are characterized by a raised , round , or dome - shaped les ion that is typically filled with a thick , yellow ish - brown crust y material . Ker ato ac anth omas are typically caused by sun exposure , chemical carcinogens , cancer drugs such as vemurafenib and diabrafenib, recent injury to the skin, and other factors such as genetics and hormonal changes . Human papilloma virus (HPV) has been also suggested as a causal factor. A new case report published in JMIR Dermatology describes a novel case of a healthy 86-year-old man who experienced an eruption of multiple keratoacanthomas 2 weeks after vaccination with the Moderna mRNA-1273 vaccine. 12 days after his second dose of the vaccine, he began to experience severe pruritus of the lower pretibial area, and within 2 days, he noticed red no

HLA-A*11 and vaccine-induced thyroiditis

The  human leukocyte antigen  ( HLA ) genes  encode proteins essential for mounting an immune response.  Immune systems of people with specific HLA types may be better or worse at mounting an immune response and generating antibodies to specific proteins.  HLA-A11  (A11) is one of serotypes with 10.8% frequency in worldwide population. It's most  common in East Asia. One of its variations,  HLA-A*11, has been linked with vaccine-induced  subacute thyroiditis (V-SAT) . This rare transient inflammatory thyroid disease is usually associated with pain and tenderness of the gland, as well as generalized somatic symptoms: from anxieties,  difficulty swallowing, changes in appetite,  malaise and fatigue to  complete prostration for weeks or months if left untreated. HLA-A*11:01:01:01 was found to be significantly associated with the severity of COVID-19.   SAT is the most common thyroid dysfunction following SARS-CoV-2 vaccination. There have been multiple reports of post-vaccination thy