Systemic lupus erythematosus myocarditis after COVID-19 vaccination

A 72-year-old female underwent kidney transplantation in 2004 due to a chronic kidney failure secondary to membranoproliferative glomerulonephritis The patient has been in chronic hemodialysis since 2017 after renal graft dysfunction due to chronic rejection. She presented to the emergency room with pleuritic chest pain one week after vaccination with the third dose of BNT162b2 mRNA. Physical examination was unremarkable. 

Despite no history of autoimmune diseases, her ANA IFA (a first line screen for detecting the presence of autoantibodies) was positive in 1:160 dilution, anti-dsDNA, and anti-histone antibodies were also positive.

FDG PET/CT was requested, showing a focal myocardial and pericardial inflammatory process in the cardiac apex. Given the results, Systemic lupus erythematosus (SLE) diagnosis was made with myocardial affection. She was immediately started on oral prednisone (1 mg/kg) and beta-blockers improving clinically. At the three-month follow-up visit, the patient was asymptomatic.

Several cases of post-vaccinal lupus were described in medical literature. A 68-year-old Caucasian woman without history of autoimmune conditions developed it after her first dose of Pfizer vaccine. A 22-year old woman was diagnosed with SLE after second dose of Covishield (Oxford Astrazeneca) vaccine. 


REFERENCES

Sogbe M, Blanco-Di Matteo A, Di Frisco IM, Bastidas JF, Salterain N, Gavira JJ. Systemic lupus erythematosus myocarditis after COVID-19 vaccination. Reumatol Clin (Engl Ed). 2023 Feb;19(2):114-116. doi: 10.1016/j.reumae.2022.06.006. PMID: 36739118; PMCID: PMC9892927.

Lemoine C, Padilla C, Krampe N, Doerfler S, Morgenlander A, Thiel B, Aggarwal R. Systemic lupus erythematous after Pfizer COVID-19 vaccine: a case report. Clinical Rheumatology. 2022 May;41(5):1597-601.

Patil S, Patil A. Systemic lupus erythematosus after COVID‐19 vaccination: A case report. J Cosmet Dermatol. 2021;20:3104–3105. 10.1111/jocd.14386 

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