Medical Case Reports

A n Asian man in his 70s  developed a fever at home 11 days after his second dose of the mRNA vaccine BNT162b2 (disease day 0).  On disease day 10, he was admitted to the hospital f ollowing to his worsened status. On arrival, his oxygen saturation was 56% while he was breathing ambient air. R emdesivir, methylprednisolone treatment was initiated along with a single dose of 8 mg/kg tocilizumab . He required a noninvasive, positive-pressure ventilator for hypoxemia. On disease day 19, his oxygen level abruptly dropped, and  intubation  was needed. On disease day 26, soon after extubation, he developed  pneumothorax and  acute respiratory distress syndrome. H igh SARS-CoV-2 viral load (Delta variant, although s everal mix alleles were found in the specimens collected on disease days 27-29 ) was observed until 1 month after onset.  He died on disease day 31.  One year before admission he successfully  received six c...

Immunotyping of 41 clinically well-characterized, mechanically ventilated (MV), ICU COVID-19 patients, 21 of whom died, and 18 MV influenza patients, showed that fatal COVID-19 infection is driven by uncoordinated inflammatory responses. Previous studies suggested that in severe COVID-19 the gradient of immune activation characterized by elevated levels of inflammatory cytokines is either very high or very low. In this study, COVID patients who died had significantly elevated levels of a number of immune mediators including GM-CSF, CXCL10, IL-6, CCL20, CCL2, coagulation factor III, IL-15, TFPI (tissue factor pathway inhibitor), and CCL19.  Elevated CXCL10 and GM-CSF were the strongest signals, while CXCL5 had the strongest negative association. CD40 ligand, EGF, and CXCL1 were also decreased. Elevated soluble CD40L and EGF were associated with survival in both flu and COVID, but the underlying reasons appear different. Unexpectedly, median serum concentration of all cytokines/chem...

SUMMARY   We report a case from an ongoing COVID-19 vaccines long-term safety study . We describe a fatal SARS-CoV-2 breakthrough infection occurring after a serious adverse reaction to ChAdOx1 nCov-19 vaccine. Two years into the outbreak, COVID-19 treatment and preventive care are still not sufficiently personalized. Radiographic and laboratory findings commonly used to monitor progression to severe disease fail to select appropriate treatment or subsequent immunization regimen while predicting response to therapy remains a clinical challenge. Retrospectively analyzing post-immunization adverse events helps in understanding the relationship between host susceptibility and vaccine efficacy, which may ultimately lead to improved interventions. CASE PRESENTATION An otherwise healthy 84-year-old male tested positive for SARS-CoV-2 with a reverse transcription-polymerase chain reaction (RT-PCR) about 2 months af...