Medical Case Reports

A previously healthy 46-year-old woman who never had COVID-19, developed pleuritic chest pain on the tenth day after receiving the third dose of BNT162b2 and was subsequently admitted to the emergency department.  Physical examination of the chest revealed a unilateral pleural effusion (accumulation of fluid in the pleural space). During the focused lung ultrasound, a small left pleural effusion was detected by placing the transducer in the left posterior axillary line at the lower part of the chest (zone L3).  She was negative to influenza A, A/H1, A/H3, B; Adenovirus; coronavirus HKU1, NL63, 229E, OC43; parainfluenza virus types 1, 2, 3, 4; RSV; human rhinovirus/enterovirus; human metapneumovirus, Middle East respiratory syncytial coronavirus; SARS-CoV-2 as well as bacteria bordetella pertussis, bordetella parapertussis, Chlamydia pneumoniae, and Mycoplasma pneumoniae. She was also negative to antinuclear antibodies (ANA), anti-double-stranded DNA (anti-dsDNA), rheumatoid f...

A 14-year-old Japanese girl died unexpectedly 2 days after receiving the third dose of the BNT1262b2 mRNA COVID-19 vaccine. Autopsy findings showed congestive edema of the lungs, T-cell lymphocytic and macrophage infiltration in the lungs, pericardium, and myocardium of the left atria and left ventricle, liver, kidneys, stomach, duodenum, bladder, and diaphragm. Since there was no preceding infection, allergy, or drug toxicity exposure, the patient was diagnosed with post-vaccination pneumonia, myopericarditis, hepatitis, nephritis, gastroenteritis, cystitis, and myositis. Arrhythmia of atrial origin was assumed as the cause of cardiac failure and death.  Histopathology of the heart (left atrium), lung, liver, kidney, diaphragm, stomach, duodenum, and bladder of the child (Figure) show severe infiltration.  Multisystem inflammatory syndrome is a life-threatening condition associated with elevated inflammatory markers and multiple organ injury. A diagnosis of exclusion, it has...

Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's disease, is a rapidly progressive, invariably fatal neurological disease that attacks the nerve cells responsible for controlling voluntary muscles in the central nervous system, with death usually occurring within two to five years of symptom onset.  In this case study, a previously asymptomatic 47-year-old male presented with left-sided weakness, declining speech, dysphagia, and recurrent falls for nine months, which began one day after receiving the J&J/Janssen viral vector COVID -19 vaccine. His family history of ALS included his grandmother being diagnosed with it.  After getting the vaccine, the patient initially experienced painful inflammation at the injection site. Within a week, he began to feel weakness in his left arm and a weak hand grip. Over the following months, this weakness progressed to his entire left side, and he started to experience declining speech, difficulty swallowing, and falling d...

Multiple sclerosis (MS) is a chronic autoimmune disorder that affects the central nervous system, leading to a wide range of neurological symptoms.  While this disease is most commonly diagnosed in individuals in their 20s and 30s, it is rare for MS to result in sudden death in younger patients.  A 19-year-old male soldier received the second dose of the COVID-19 vaccine (Pfizer-BioNTech). 3 months later, he started experiencing epileptic seizures during sleep and was admitted to an outside hospital. Since the first seizure, he presented with 5 more generalized tonic-clonic seizures within a week. He had no other symptoms or signs of meningeal irritation. Cerebrospinal fluid (CSF) analysis including culture and viral polymerase chain reaction revealed no abnormalities except for mild pleocytosis. Oligoclonal band and aquaporin-4 antibodies were not detected in the CSF and serum. Brain MRI performed 1 day after the seizure revealed T2 hyperintensities in the periventricula...

While there are certain genetic and environmental factors that may increase an individual's risk of developing anaphylaxis in general, there is currently no specific biomarker or genetic test that can reliably predict an individual's risk of anaphylaxis to vaccines. The decision to administer a vaccine to an individual with a history of anaphylaxis is recommended to be made on a case-by-case basis.  Recent paper describes a case where PEG skin testing was useful in predicting an allergic reaction to BNT162b2 vaccine.  We note that there have been some reports of successful PEG skin testing in certain non-COVID-vaccine-related cases in the past, but the reliability of this method has not been established through systematic research studies and the skin test could be life-threatening in some cases.  There is a lack of standardization in the PEG skin test procedure, including the concentration and method of application of the PEG test solution, which makes it difficult to in...

 A 21-year-old Caucasian woman with a medical history of hypothyroidism secondary to Hashimoto’s thyroiditis, chronic migraine headaches without aura, and anxiety disorder presented to the outpatient electrophysiology clinic following three episodes of syncope within three months - one day, 4 week and 8 weeks after the first dose of the Pfizer BioNTech SARS-CoV-2 vaccine. She was placed on a two-week Holter monitor to rule out conduction abnormalities. An echocardiogram revealed normal left ventricular function, normal wall motion, and no evidence of pericardial effusion, but four days later she was found to have been in a normal sinus rhythm that progressed to sinus bradycardia followed by a sinus arrest with no underlying escape for 8.4 seconds that correlated with her syncope. She then had a few beats of sinus bradycardia, followed by another 3.1-second pause of the same mechanism. Since Holter monitoring during successive episodes showed progressive bradycardia followed by...

Previously we presented case reports with oral side effects of COVID-19 vaccine due to mucocutaneous reactions. Trigeminal neuralgia (TN) could be another reason for oral manifestations, including severe tooth pain.  A 45-year-old female was admitted to a research hospital with 3 days of facial and jaw pain, fatigue and toothache following the first dose of Pfizer-BioNtech vaccine against SARS-CoV-2. The features of the pain were unilateral, acute onset, and severe, on the lower right side of the face. It was triggering with brushing her teeth and putting on makeup. The case was considered as trigeminal neuralgia. Pregabalin failed to control the pain, while amoxicillin/clavulanic acid (despite normal X-rays) led to angioedema and worsening of her general condition. However, with steroid treatment, the patient eventually recovered.  A 36-year-old woman was admitted to the Emergency Ward due to chronic pain attacks in the left side of her face. The pain appeared tw...