Polyarteritis Nodosa Following Vaccination

Polyarteritis nodosa (PAN) is a rare, but serious autoimmune disease that affects the medium-sized arteries, can block the flow of blood and nutrients and affect many different organs in the body, including the skin, joints, nerves, kidneys, and gastrointestinal tract. 

It is a complex condition with multiple genetic and environmental factors likely playing a role. Genetic factors that have been associated with PAN include variations in MEFV, TNFAIP3, CECR1, DADA2, and ITGB2 genes. 


A healthy 59-year-old woman presented to the emergency department with a two-day history of progressively worsening abdominal pain, melena, and postprandial nausea. The patient had no significant chronic medical history and no recent infections. She was recently vaccinated with the second dose of the mRNA-1273 vaccine against SARS-CoV-2 approximately two days before her presentation. Physical examination was significant for diffuse tenderness to palpation of the abdomen with rebound tenderness of the right upper quadrant. Laboratory values were significant for a mild leukocytosis and an elevated erythrocyte sedimentation rate. 

A computerized tomography (CT) scan of the abdomen showed numerous vascular irregularities in the celiac axis, bilateral renal arteries, and inferior mesenteric artery consistent with vasculitis. There was significant stenosis of the distal branch of the right renal artery resulting in renal parenchyma ischemia with heterogenous enhancement, as seen in the figure. 


The patient was subsequently diagnosed with polyarteritis nodosa and was started on intravenous methylprednisolone. Her symptoms had significantly improved, and she was started on methotrexate for remission maintenance immunosuppression. 

Several cases of PAN have been reported secondary to COVID-19 vaccination including cutaneous PAN in a 52-year-old woman after vaccination with the ChAdOx1 nCoV-19 vaccine and a 61-year-old man diagnosed with PAN and epididymitis following the BNT162b2 vaccine. 10 cases of possible PAN from the HBV vaccine are described in VAERS.


REFERENCES

Srichawla BS. Polyarteritis Nodosa Following mRNA-1273 COVID-19 Vaccination: Case Study and Review of Immunological Mechanisms. Cureus. 2023 Jan 10;15(1):e33620. doi: 10.7759/cureus.33620. PMID: 36788908; PMCID: PMC9911313.

Cutaneous polyarteritis nodosa following ChAdOx1 nCoV-19 vaccination. Su HA, Hsu HT, Chen YC. Int J Dermatol. 2022;61:630–631.

Possible case of polyarteritis nodosa with epididymitis following COVID-19 vaccination: a case report and review of the literature. Ohkubo Y, Ohmura SI, Ishihara R, Miyamoto T. Mod Rheumatol Case Rep. 2022

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