Medical Case Reports

Patients with adrenal insufficiency who are on glucocorticoid replacement therapy face unique challenges when it comes to vaccination. In most cases, conventional vaccines like those for the influenza virus don't necessitate an increase in glucocorticoid dose. However, with the advent of COVID-19 mRNA vaccines, there have been reported cases of adrenal crisis in patients with secondary adrenal insufficiency. A new paper explores three cases that shed light on this issue.  Case 1: Idiopathic Isolated ACTH Deficiency A 78-year-old man with idiopathic isolated ACTH deficiency received the second dose of the BNT162b2 mRNA vaccine. He decided not to take hydrocortisone (HC) on the day of vaccination. The following day, he experienced fatigue, nausea, vomiting, and appetite loss. He did not receive HC and ended up in the emergency department two days later, with severe general fatigue, nausea, vomiting, hyponatremia, and relative hypotension. His symptoms resolved a day after administrat...

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 vacc...

As fewer and fewer people opt for additional boosters of COVID-19 vaccine, are those who never had vaccine adverse events experiencing new side effects? VAERS reports many uneventful vaccinations even with extra doses given too soon after previous ones. Yet there are cases such as  abdominal pain , or Addisonian crisis  after the 5th dose. One case of systemic adverse reactions (14%, out of 7 respondents) was self-reported after the 5th booster in a survey-based study . The study also showed higher incidence of cutaneous reactions after 3rd vs 2nd dose of the same vaccine.  89 out of  234  vaccinated individuals  (38%)   who filled out  a web-based survey in Turkey  reported  at least one cutaneous adverse event related to the vaccination.  The responders cumulatively received 771 doses.  The mean number of vaccine dosages was 3.29 ± 0.76 (minimum:1, maximum:5). Sixty‐six (28.2%) cases had at least one accompanying systemi...

A 69-year-old male with a past medical history of hypertension and prediabetes presented with worsening fatigue, polyuria, polydipsia, blurry vision, and 14 pounds of weight loss over three weeks that started soon after receiving the 3rd booster dose of BNT162b2 mRNA vaccine. He also reported intermittent upper abdominal pain and episodic ambulatory lightheadedness for two weeks. He also reported a loss of taste and smell for two weeks with a diminished appetite. His family history was significant for some members with Graves' disease and celiac disease. He was a non-smoker with no alcohol or illicit drug use. On examination, he was afebrile with normal blood pressure, sinus tachycardia, and mild tachypnea. Physical exam was remarkable for mild upper abdominal tenderness and dry oral mucosa.  Complete blood count (CBC) was normal; blood glucose was severely elevated with mild corrected hyponatremia; elevated anion gap metabolic acidosis with glucosuria and ketonuria. He recei...

Subacute thyroiditis (SAT) is a thyroid inflammatory disease associated with viral infections. Its pathogenesis is still unclear.   Several   SAT  cases associated with SARS-CoV-2 infection as well as COVID-19 vaccination have been reported.  A case of a 5 2-year-old female with SAT after the third dose of  COVID-19   mRNA vaccine  BNT162b2 (Pfizer-BioNTech) was documented with laboratory tests and ultrasound examination. She needed therapy during the acute phase and subsequently thyroxine supplementation. A 34-year-old male physician was admitted to the endocrinology outpatient clinic on the 20th day after the first dose of mRNA-1273 vaccination. He reported fatigue, headache, weakness in the lower extremities, sweating, and weight loss, which started 5 days after the first dose of the vaccine; the first symptom was a lump sensation when swallowing. The course of the vaccination and his symptoms are shown in the Figure.  As the patient was...