Medical Case Reports

A 51-year-old woman, with anemia and rib fractures, diagnosed with IgG-kappa multiple myeloma (MM) in 2012, initially achieved complete remission. However, in 2020, she experienced a clinical relapse followed by a biochemical relapse. In 2021, she received two doses of the mRNA vaccine BNT162b2 against SARS-CoV-2, yielding no serological response. Subsequently, before undergoing CAR T-cell therapy, she received a third vaccine boost in March. Two months later, in July 2022, she contracted a SARS-CoV-2 infection, presenting with a dry cough and low-grade fever. Due to relapsed/refractory multiple myeloma (R/R MM), the patient underwent various treatments, including CAR T-cell therapy. Despite achieving minimal residual disease negativity post-infusion, she developed severe COVID-19 pneumonia, posing challenges to her clinical management.  Her prolonged hospitalization was marked by a complex interplay of factors: pulmonary embolism, immune deficiencies including B-cell aplasia ...

Genetic factors that increase the risk of COVID-19 vaccine-induced adverse events are currently being investigated. A new article is presenting a case of T-LGL, T-cell large granular lymphoma, a rare lymphoproliferative disorder, in a patient who received a COVID-19 mRNA vaccine. The authors analyzed the results of gene sequencing for pathogenic mutations but did not find any known variations associated with T-LGL, particularly not in STAT3 or STAT5b, harboring the most common gain-of-function mutations. However, the article provides evidence that the vaccine induces STAT3 activation through TLR stimulation, which may potentially exacerbate STAT3-dependent diseases. Interestingly, expansion of T cells causing progressive lymphadenopathy following mRNA vaccination has been reported in a patient with angioimmunoblastic T Cell lymphoma, indicating that further investigation is needed to understand the potential genetic and immune-related factors that increase the risk of lymphoma after va...

A previously healthy 28-year-old woman received the primary dose of adenovirus type 26 (Ad26) viral vector-based COVID-19 vaccine 35 (Janssen Pharmaceuticals,  Johnson & Johnson vaccine ). A few days later, she developed a swelling at the injection site. Over the next three months, the nodule progressively enlarged to become a plaque  with associated pain, warmth, and tingling sensation. She also developed cervical and left axillary lymphadenopathy, intermittent fevers, fatigue, and unintentional weight loss. Presumptive treatment for cellulitis with several courses of oral antibiotics was ineffective. According to the WHO-EORTC classification, the clinical and histopathologic findings were consistent with SPTCL -  Subcutaneous panniculitis-like T-cell lymphoma,  a rare type of lymphoma that mainly affects the skin . Lymphomas are cancers that result from a type of white blood cell that grows out of control.  T-cell lymphoma  begins in white bloo...

  Fatal COVID-19 breakthrough infection case after unspecified mRNA vaccine Fatal breakthrough infection after anti-BCMA CAR-T therapy highlights suboptimal immune response to SARS-CoV-2 vaccination in myeloma patients Adolfo Aleman, Oliver Van Oekelen, Bhaskar Upadhyaya, Sarita Agte, Katerina Kappes, Katherine Beach, Komal Srivastava, Charles R. Gleason, PVI study group, Bo Wang, Tarek H. Mouhieddine, Kevin Tuballes, Daniel Geanon, Zenab Khan, Ana S. Gonzalez-Reiche, View ORCID ProfileHarm van Bakel, Nicole W. Simons, Konstantinos Mouskas, Alexander W. Charney, View ORCID ProfileAdeeb Rahman, Seunghee Kim-Schulze, VEmilia M. Sordillo, Florian Krammer, Carlos Cordon-Cardo, Nina Bhardwaj, Sacha Gnjatic, Miriam Merad, Brian D. Brown, Larysa Sanchez, Ajai Chari, Sundar Jagannath, Viviana Simon, Ania Wajnberg, Samir Parekh Mount Sinai Hospital 78 Icahn School of Medicine 79 One Gustave L. Levy Place, Box 1185 80 New York, NY 10029 doi: https://doi.org/10.1101/2021.05.15.21256814 SUM...