Medical Case Reports

Severe post-vaccinal complications could be driven by an overactive immune response. In a new case series , recently published in Cureus, three rheumatic disease patients with low disease activity needed hospitalization and new biological treatments, and one patient died after her 4th dose of SARS-CoV-2 mRNA vaccine. Cytokine analysis showed elevated levels of IL-1β, IL-6, IL-17, and TNF-α, indicating a cytokine storm, possibly triggered by IL-6 amplification (IL-6 Amp). This mechanism involves excessive IL-6 production through a feedback loop activated by simultaneous stimulation of NF-κB and STAT3 pathways Case 1: Acute Exacerbation of Interstitial Pneumonia in an 80-Year-Old Woman An 80-year-old woman with a history of rheumatoid arthritis (RA) had been in remission for five years thanks to a regimen including subcutaneous tocilizumab (TCZ-SC) and tacrolimus. However, after receiving the Pfizer-BioNTech vaccine, she developed severe dyspnea requiring oxygen. Her CT scan revealed new...

A Case report published today describes new-onset acute psychosis as a manifestation of lupus cerebritis following concomitant COVID-19 infection and vaccination.  A 26-years old female with a family history of a mother diagnosed with schizophrenia, and no personal medical or psychiatric history, was diagnosed with mild COVID-19 infection four days after receiving the second dose of Pfizer-BioNTech COVID-19 vaccine.  She was asymptomatic when she received the COVID-19 vaccine. Two weeks later, she presented to the emergency department with chest pain, where physical examination revealed a heart rate of 110/min. A cardiac ultrasound examination showed a pericardial effusion suggestive of pericarditis. She was started on aspirin and colchicine, with a slow recovery. One month after receiving the vaccine, she presented to the psychiatric emergency department with acute psychomotor agitation, incoherent speech and total insomnia evolving for five days. She was firstly diagnosed wi...

Polyarteritis nodosa (PAN) is a rare, but serious autoimmune disease that affects the medium-sized arteries, can block the flow of blood and nutrients and affect many different organs in the body, including the skin, joints, nerves, kidneys, and gastrointestinal tract.  It is a complex condition with multiple genetic and environmental factors likely playing a role. Genetic factors that have been associated with PAN include variations in MEFV, TNFAIP3, CECR1, DADA2, and ITGB2 genes.  A healthy 59-year-old woman presented to the emergency department with a two-day history of progressively worsening abdominal pain, melena, and postprandial nausea. The patient had no significant chronic medical history and no recent infections. She was recently vaccinated with the second dose of the mRNA-1273 vaccine against SARS-CoV-2 approximately two days before her presentation. Physical examination was significant for diffuse tenderness to palpation of the abdomen with rebound tenderness of ...

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 patien...

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a  rare disease with an annual incidence of approximately 20 per million population in Europe and North America. The aetiopathogenesis is complex and is mainly driven by the gene environment interactions. Genes associated with this condition include HLA-DQ (variations in which have been linked to asymptomatic COVID), IL-5 and GPA33. COVID-19 heralds a poor prognosis in those with preexisting AAV with over 50% patients having severe disease. Loss of smell is observed in AAV population more frequently (~50%) than in others (~35%).  70-year-old Chinese woman presented  with poor appetite and nausea 4 hours after receiving the first dose of CoronaVac vaccine. These symptoms progressively worsened, followed by fatigue and foamy urine 10 days later. Her medical history included hypertension, hyperlipidemia, and kidney stones. She had penicillin allergy and no family history of ANCA-associated vasculitis...

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...

A 37-year-old South Asian woman  with a 7-year history of rheumatoid arthritis (on bi-weekly tocilizumab injections) tested SARS-CoV-2 positive 9 month after receiving her vaccination (JNJ-78436735). She experienced persistent headache and fatigue for >6 weeks after infection and continued to test intermittently antigen+ for 14 weeks post-infection despite no overt exposure to SARS-CoV-2 infected individuals. She lived alone, did not leave her residence without a surgical-grade N95 mask, and never removed the mask in public. She was subsequently prescribed a 5-day course of nirmeltravir/ritonavir 300/100 mg twice daily. Initially, all PASC symptoms resolved, and the patient tested antigen negative 3 weeks after completion of nirmeltravir/ritonavir, but the symptoms and antigen positivity subsequently reappeared at 4 weeks (see figure). Assessment of adaptive immune responses demonstrated that nirmatrelvir/ritonavir and tocilizumab treatment decreased antiviral and autoreactive T...

Interstitial lung disease is the most common and serious complication of the inflammatory muscle diseases  It can be caused by long-term environmental exposures or autoimmune diseases such as rheumatoid arthritis, but in some cases the causes remain unknown. In a study of  545 patients with  interstitial lung disease (ILD) in Japan,  ~3% of patients  reported that COVID-19 vaccination caused an adverse reaction of worsening respiratory symptoms. F our patients experienced acute exacerbations. Two of them had collagen vascular disease-associated ILD, one had nonspecific interstitial pneumonia, another had unclassifiable idiopathic pneumonia, and none had idiopathic pulmonary fibrosis. In addition to adverse reactions, increased prevalence of non-response to vaccine was observed in patients with autoimmune-systemic-disease-related interstitial lung disease  (p = 0.009) Several other cases were described in medical literature two were so severe ...

A 78‐year‐old woman with no personal or family history of abnormal bleeding noticed a bruise on her thigh 2 weeks after her second COVID‐19 mRNA vaccination (Pfizer‐BioNTech). Her skin bruise persisted and on day 38, a new bruise appeared on her left hand. On day 50, she visited a hospital because of pain and swelling in the left hand.  Computed tomography (CT) scans showed intra‐articular bleeding in her left shoulder and asymptomatic central nervous system (CNS) bleeding. Blood tests revealed normocytic anemia. While factor XIII/13 (F13) antigen level was slightly reduced, and its activity was below the detection limit. The patient died of CNS bleeding despite treatment.  READ MORE REFERENCE Shimoyama S, Kanisawa Y, Ono K, Souri M, Ichinose A. First and fatal case of autoimmune acquired factor XIII/13 deficiency after COVID‐19/SARS‐CoV‐2 vaccination. American journal of hematology. 2022 Feb;97(2):243.

A ~30-40-year-old male was given a dose of the AstraZeneca vaccine in April 2021. Within days, he started to have excruciating back pain. Then came the tingles on the side of his face — and then, paralysis. He was diagnosed with Guillain-Barré Syndrome (GBS), a rare condition that affects the nervous system. It can cause paralysis, muscle weakness, and even death.  This condition has been linked to COVID-19 vaccination with all types of vaccines and wide range of ages (eg,  Pfizer: 67-year-old male , Pfizer: 14-year old male ,   Astrazeneca: 66-year old  male) Review of 9 cases that occurred in persons with a mean age of 57.8 (range 20–86) years,  56.4% male, showed that most of the reported case-patients received ChAdOx1-S (25/39), followed by BNT162b2 (12/39) (Pfizer-BioNTech), Ad26.COV2.S (1/39) (Johnson & Johnson), and CoronaVac (1/39). The GBS rate after COVID-19 vaccination ranged from 1.8 to 53.2 cases/1 million doses. There w...

A 50-year-old multiple-sclerosis patient fails to mount a humoral response after the first, second and third Moderna vaccination and even after COVID-19. A 50-year-old female with relapsing remitting multiple sclerosis since 2013, treated with ocrelizumab since 2018, was  vaccinated with Spikevax (Moderna) in April and May 2021  and received the booster vaccination in October. One to two weeks prior to the ocrelizumab infusions in March and September 2021 the patient was B-cell depleted.  Eleven days after the booster vaccination the patient was tested positive for SARS-CoV-2 by PCR. She experienced symptoms of dyspnea and fever and was admitted to the hospital for eleven days where she was treated with oxygen and dexamethasone.  After each vaccination and even  28 days after third vaccination and 17 days after positive SARS-CoV-2 PCR, the patient remained negative for anti-RBD as well as anti-nucleocapsid protein antibodies. The patient fully recovered from COV...

A 65-year-old woman experienced mild abdominal pain shortly after  receiving the first dose of Moderna-COVID-19 vaccine. She tested negative for hepatitis A virus, human immunodeficiency virus, cytomegalovirus, Epstein-Barr virus and herpes simplex virus type 1 and 2, as well as hepatitis B, C and E viruses. Her blood tests and thyroid function were normal,  except elevated ALT/AST and positive antinuclear antibody.   Five weeks after vaccination, the patient presented with jaundice and choluria. Liver profile was worsening, and IgG levels were now elevated.    Percutaneous liver biopsy was performed, revealing a marked expansion of the portal tracts due to dense inflammatory infiltrate, with aggregates of plasma cells;  The score of simplified diagnostic criteria of the International Autoimmune Hepatitis Group was 8, indicative of autoimmune hepatitis (AIH). Treatment with prednisolone 60 mg/day was started with a quick improvement of liver ...

Two fatal breakthrough infections reported for  sufferers of Systemic Autoimmune Rheumatic Diseases (SARDs). They were 57 (vaccinated with Pfizer/Biontech) and 78 (Moderna) per supplementary table .   Among the 16 SARD patients who had breakthrough COVID-19 infections, 93% presented with symptoms. The most common symptoms reported by these individuals included fever, cough, and malaise, which affected 56%, 44%, and 38% of the patients, respectively. Six of the 16 patients were hospitalized, of which four required supplemental oxygen and one required mechanical ventilation.  Two (13%) patients died; both deceased patients had received rituximab and had interstitial lung disease Clinical characteristics and outcomes of COVID-19 breakthrough infections among vaccinated patients with systemic autoimmune rheumatic diseases Claire Cook   1 ,  Naomi J Patel   1   2 ,  Kristin M D'Silva   1   2 ,  Tiffany Y-T Hsu   2   3 ,...