Medical Case Reports

Multiple cases of  COVID-19  vaccine-triggered vulvar ulcers have been reported in medical literature.  A  12-year-old healthy girl  without prior sexual activity nor history of oral or genital ulcers presented with a 1-day history of vulvar ulcers with associated swelling and pain three days after receiving the second dose of the Pfizer COVID-19 vaccine.  Her condition resolved within 10 days after treatment.  A 12-year-old otherwise-healthy female patient presented with painful vulvar ulcerations that had been present for approximately 5 days, starting from 2 days after her 2nd Pfizer vaccine.  Ulcers healed over the course of 2 weeks after treatment.  A virginal 14-year-old girl reported vulvar pain and visible lesion. Exam findings were consistent with vulvar aphthous ulcers. Two days prior to the onset of her symptoms she received her second Pfizer-BioNTech COVID-19 vaccine. The evening of vaccine administration, she ex...

A 12-year-old boy with unremarkable family and personal medical history presented with chest pain after the first dose of BNT162b2 vaccine. One day after vaccination, he developed fever and fatigue, followed by chest pain the next day. At presentation his heart rate was 82 beats/min. Laboratory tests revealed elevated troponin and NT-proBNP. The ECG showed ST elevation in leads I, II, and V3–6 (as shown in the Figure).  Echocardiography revealed a left ventricular ejection fraction of 68%, mild pericardial effusion, and increased epicardial echodensity. A diagnosis of myocarditis after mRNA COVID-19 vaccination was made, and the patient was treated with 30 mg/kg of aspirin and famotidine. On the next day, the chest pain improved, and the troponin I and NT-proBNP levels decreased to 820.4 and 74 pg/mL, respectively. On the fourth day of admission, the chest pain resolved, the troponin I level decreased to 355 pg/mL, ECG was normalized, and cardiac contrast-enhanced magnetic resona...

Two more cases of hepatitis/colitis and hepatitis/MIS-C to add to the  January post .  New report describes a case similar to previously published  case reports of hepatitis after COVID-19 vaccination.  This article reports a case of hepatitis and colitis in a 52-year-old woman who was undergoing immunotherapy and was HBV positive 10 days after receiving the first Pfizer-BioNTech COVID-19 vaccine dose. Because both ICIs and the COVID-19 vaccines stimulate the immune response, the authors hypothesized that these vaccines may increase the incidence of irAEs during ICI treatment. There is a complex interplay between the immune-mediated reaction triggered by the vaccination and PD-L1 co-administration. Another case describes a 17-year-old female hospitalized for a history of fever, asthenia, cough, anorexia, abdominal pain, and vomiting. The patient has a positive familial history for autoimmune disorders (inflammatory bowel diseases, connective tissue diseases, and m...

Multisystem inflammatory syndrome in children (MIS-C) and adults (MIS-A) can follow SARS-CoV-2 infection. MIS-C was primarily described for  16-20 year olds, racial/ethnic minority populations and children with comorbidities .  MIS-C and MIS-A can be also induced by  vaccination without current COVID-19 infection. In adults, many individuals who experienced it  were vaccinated 11-78 days after COVID-19-like illness . One case when a 30-year-old male was vaccinated 6 and 28 days after positive test was fatal . In children, only ~25% had COVID-19 in the past . Average age was lower than in MIS-C triggered by the virus.   Here are a few case reports.  A 12-year-old male was presented to the hospital with acute encephalopathy, headache, vomiting, diarrhea, and elevated troponin two days after the second dose of the Pfizer-BioNTech COVID-19 vaccine. Symptoms developed within 24 h. Brain magnetic resonance imaging revealed a cytotoxic splenial lesion of the ...