Pulmonary manifestations of vaccination

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 factor (RF), immunoglobulin G4 (IgG4), anti-cyclic citrullinated peptide (anti-CCP), and QuantiFERON. The varicella-zoster virus antibody immunoglobulin G (IgG) that were sent yielded positive results, whilst IgM antibodies were negative. 

This case shows that COVID-19 vaccination may be associated with unilateral pleural effusion in healthy individuals without the concurrent diagnosis of myocarditis or pericarditis, nor any infection. An association between the vaccination and myocarditis or pericarditis with pleural effusion and exacerbation of COPD have been previously reported. 

A 94-year-old man presented with acute onset, rapidly progressive dyspnea and fatigue that started on the second day after his first ChAdOx1 nCoV-19 vaccination. In the past, he lived independently managing his hypertension and hyperlipidemia with amlodipine and olmesartan regularly. Otherwise, he had no comorbidities such as heart failure, coronary artery disease, renal disease, cirrhosis, autoimmune disease, or malignancy. Upon arriving at the emergency department, the patient was hypotensive (99/51 mmHg) and oxygen desaturated (94%, under nasal cannula with 3-L of oxygen per minute). He was afebrile (35.5 degrees Celsius) and had a pulse rate of 61 beats per minute, and a respiratory rate of 22 breaths per minute. A physical examination revealed a distant heart sound and decreased breathing sounds over bilateral lower lung fields. Chest X-ray revealed the water bottle sign and bilateral costophrenic angle blunting while COVID-19 test was negative. Vaccine-induced polyserositis (pericarditis and pleurisy) was diagnosed. He had Bilateral Refractory Pleural Effusion.

Marked increase of interferon-β after BNT162b2 mRNA vaccination leading to polyarthritis with pleurisy was also reported for a woman in her 90s without a significant medical history and a man in his 70s with a history of myocardial and cerebral infarction but no history of arthritis. 


REFERENCES

Athanasiou NK, Antonoglou A, Ioannou M, Jahaj E, Katsaounou P. Unilateral Pleural Effusion after Third Dose of BNT162b2 mRNA Vaccination: Case Report. J Pers Med. 2023 Feb 23;13(3):391. doi: 10.3390/jpm13030391. PMID: 36983574.

Li GY, Lee CC, Huang CC. Acute Polyserositis with Cardiac Tamponade and Bilateral Refractory Pleural Effusion after ChAdOx1 nCoV-19 Vaccination. Vaccines. 2022 Aug 10;10(8):1286.

Shimagami H, Yamaguchi Y, Kato Y, Kumanogoh A. Marked increase of interferon-β after BNT162b2 mRNA vaccination: a case of polyarthritis with pleurisy. BMJ Case Reports CP. 2022 Mar 1;15(3):e246533.

Comments

Post a Comment

Popular posts from this blog

A New Onset of Ulcerative Colitis post-2nd-breakthrough-COVID-19

Image
A 21-year-old non-smoking Caucasian male with a history of acute pancreatitis but no other medical issues or family history had two doses of the BNT162b2 mRNA COVID-19 vaccine.  Four months after the second dose he had his first episode of COVID-19. Although not hypoxic, he felt pretty unwell for a week, with a severe cough, fever, generalized body ache, headache, and loss of taste. He received the third dose of the vaccine two months after recovering from COVID. Nine months after the third dose, he had the second episode of COVID-19, during which he was mildly unwell for three days, recovered, and did not require any anti-viral medication or antibiotics. One week post the second episode of COVID-19, he developed diarrhea and abdominal pain. It then progressed to bloody diarrhea. Ulcerative colitis was diagnosed based on his clinical symptoms, biopsy changes, and the exclusion of other causes.  There are ten published case reports about the newly diagnosed ulcerative colitis associate
Read more

COVID in May

Image
Concerns about a potential resurgence of COVID-19 are mounting as summer 2024 approaches.  This is driven by several indicators, including social media posts, healthcare data, and wastewater surveillance across different regions. Our study findings corroborate this trend.  While many forecasters anticipate a surge, others expect a gradual increase through the end of May, and then a decline again around early June. Reports from social media suggest emerging clusters of COVID-19 in Texas, several Canadian provinces, the UK, and on cruises in northern regions such as a Norwegian cruise to Alaska.  Data from Alberta's Respiratory virus dashboard   (total weekly laboratory-confirmed COVID-19 cases) and wastewater surveillance in Calgary indicate an uptick in COVID-19 cases starting April 2024. The most recent statistics from Alberta Health reveal a significant increase in hospitalizations due to COVID-19, with 114 individuals currently hospitalized—an increase of more than 20% over two
Read more

Chronic SARS-CoV-2 Shedding

Image
Chronic viral shedding, a condition where the virus continues to be released from an individual's body long after the initial infection, has been observed in many infectious diseases, including COVID-19.  In such cases, individuals may remain asymptomatic or experience only mild symptoms while the virus persists. It remains detectable in repeated tests over an extended period and can still infect others even in nasal swab is negative (which happens quite often ). This was evident in our study.    Recent research by Conway et al. (2024) highlights the possibility of chronic SARS-CoV-2 infection, extending over several months and potentially years. Other studies have documented prolonged asymptomatic infections and extended viral shedding in moderate to severe beyond hospital discharge. Analysis of sequencing data on UK samples taken between 2 November 2020 and 15 August 2022 lead to estimates that 0.1–0.5% of infections may become persistent with typically rebounding high viral load
Read more