ABSTRACT
Background: Severe coronavirus disease 2019 (COVID-19) is characterized by a hypercoagulable state and antiphospholipid antibodies (aPLs) are detected in some cases. Since elevation of aPLs could be the risk of thrombosis. Aim(s): We aim to evaluate the change of aPLs' titers and the potential risk of thrombosis after vaccination against of SARS-CoV- 2 in patients with antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE). Method(s): This study comprised patients with primary APS (PAPS), APS associated with systemic lupus erythematosus (SLE/APS), SLE aPL carriers (SLE/aPL+), and SLE without aPLs (SLE/aPL-) who received the first and second dose of COVID-19 mRNA vaccine. Serum anti-cardiolipin antibody (aCLIgG, IgM), anti-beta2GPI antibody (abeta2GPI IgG, IgM) detected by chemiluminescent immunoassay (CLIA), and anti-phosphatidylserine/ prothrombin complex antibody (aPS/PT IgG, IgM) tested an in-house enzyme-linked immunosorbent assay (ELISA) were evaluated before and 4 weeks after vaccination. The cut-off values were >20.0 U/ml for aCL (IgG, IgM)/abeta2GPI (IgG, IgM), >1.2 U/ml for aPS/PT IgG and >5.2 U/ml for aPS/PT IgM. A titer elevation of more than 10% after vaccination was defined as a significant elevation. Result(s): A total of 32 patients were enrolled;4 PAPS, 9 SLE-APS, 3 SLE-aPL+, and 16 SLE-aPL- . Among aPL+ patients (n = 16), there was no significant elevation of aPLs titers after vaccination (Table). Four weeks after vaccination, aPLs positivity was detected in three patients in the SLE/aPL-group (aCL IgG, 2 patients, abeta2GPI IgG 1 patients). In the SLE/aPL+ group, two SLE/APS patients had positive abeta2GPI IgG. No acute thrombotic events were observed during the observation period. Conclusion(s): There was no significant change in aPL titers after vaccination in patients with APS and/or SLE. None of the patients developed a thrombotic event after vaccination. (Table Presented).
ABSTRACT
Background: Since COVID-19 vaccination was introduced, various adverse effects have been linked to the vaccines. In patients with hypopituitarism, adrenal insufficiency due to the side reactions including fever of COVID-19 vaccination is concerned. Clinical Case: A 33-year woman was on medical therapy including hydrocortisone (HC) for panhypopituitarism arising from surgical treatment of a pituitary adenoma in 2006. She received a COVID-19 vaccination on day X-3. On day X-2, she developed fever in the morning and became unconscious in the evening. She was brought to our hospital by her family at night on day X. She had fever of 40.5°C, low blood pressure, and Glasgow Coma Scale (GCS) of 11. Her neck was supple and she had no quadriplegia. A COVID-19 PCR test was negative. Blood tests showed elevated white blood cell count (8900/μL;reference range: 3300–8600/µL) and C-reactive protein (138.3 mg/l;reference range: 0-1.44 mg/l). Blood glucose (81 mg/dL), ACTH (<3. 00 pg/mL;reference range: 7.2–63.3 pg/mL), and cortisol (1.9 μg/dL;reference range: 2.9–19.4 µg/dL) were low. Serum electrolytes were normal. A computed tomography scan showed no abnormality. Adrenal insufficiency was suspected, and she received HC intravenously. Her blood glucose and blood pressure increased, but her disorientation persisted. Lumbar puncture with cerebrospinal fluid (CSF) examination revealed slightly elevated cell counts (8 μ/L;reference range ≤4 μ/L) with average protein and glucose levels. Magnetic resonance imaging (MRI) of the brain revealed abnormal hyperintensity in the splenium of the corpus callosum on diffusion-weighted images and decreased apparent diffusion coefficient in the lesion, suggesting clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS). During her hospital stay, she received a 7-day course of meropenem and acyclovir for suspected meningoencephalitis. Her consciousness disturbance improved to GCS of 15 on day X+1 and her fever decreased on day X+2. HSV and VZV PCR tests were negative on CSF examination, and antibiotics and antivirals were discontinued on day X+7. On day X+8, brain MRI showed complete resolution of the corpus callosum lesion. She discharged on day X+18 without any neurological sequelae. Conclusions: For most vaccines, the incidence rates of encephalitis are low at 0.1–0.2 per 100,000 vaccinated individuals (1). The present patient developed fever and adrenal insufficiency after COVID-19 vaccination, and her prolonged disturbance of consciousness after HC administration led to the diagnosis of MERS. MERS should be considered in patients with adrenocortical insufficiency who show delayed recovery from unconsciousness with HC administration after COVID-19 vaccination. Reference: (1) Huynh W, Cordato DJ, Kehdi E, Masters LT, Dedousis C. Post-vaccination encephalomyelitis: literature review and illustrative case. J Clin Neurosci. 2008 Dec;15(12): 1315-22.Presentation: No date and time listed
ABSTRACT
BACKGROUND AND AIMS: A Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), presents with severe pneumonia and fatal systemic complications. Currently, SARS-CoV- 2 vaccines are effective in reducing the risk of onset and severity of the disease. However, autoimmune diseases, including anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), have been reported as rare complications of the COVID-19 vaccine. Although the mechanism of ANCA vasculitis remains unknown, the genetic background, environmental factors and infections are involved in the development of the disease. Genome-wide association studies have identified several AAV-related haplotypes, including the human leukocyte antigen (HLA)-DRB1∗09: 01 allele. Here, we report a case of AAV with a risk HLA allele after SARS-CoV-2 vaccination (Pfizer-BioNTech) and a literature review. METHOD: Case report: A 71-year-old woman visited a clinic complaining of fever (37.0-37.5°C) and malaise, 1 week after receiving second dose of COVID-19 vaccine (Pfizer-BioNTech). Two months after her first dose, her serum creatinine (Cr) level had increased from 0.86 mg/dL to 1.2 mg/dL with high titer of MPO-ANCA (280 IU/mL, normal value <3.5 IU/mL). Urinary microscopy revealed a red blood cell count of 30-49/high power field and a urinary protein-creatinine ratio of 1.06 g/gCr. We diagnosed MPO-AAV with manifestations of renal involvement, general symptoms and the presence of ANCA, as a cause of renal progressive glomerulonephritis. A course of corticosteroids and intravenous cyclophosphamide was initiated. After treatment, her general symptoms and urinary abnormalities disappeared, and renal insufficiency was improved as well. Three months later, the MPO-ANCA titer decreased to 27.4 IU/mL. We examined a human leukocyte antigen (HLA) haplotype and her allele was HLA-DRB1∗09:01, which is a known risk allele of MPO-ANCAassociated vasculitis. RESULTS: Review: Until November 30, 2021, we searched PubMed, including the case report study and seven cases have been reported as De novo AAV after SARS-CoV-2 vaccination. The mean age of patients was 72.5 years (three women and four men). The onset of symptomatic symptoms, such as fever, headache and malaise, ranged from the day after the first dose to 2 weeks after the second dose;consequently, renal dysfunction was detected. In six patients (except for our case), histological findings showed pauci-immune crescentic glomerulonephritis. Most patients received initial induction immunosuppressive therapy, including corticosteroids and cyclophosphamide, followed by maintenance therapy. The renal involvement of six patients improved, but one patient with severe renal dysfunction developed end-stage renal disease. Information on HLA allele was not available in any case. CONCLUSION: This is the first case report of De novo AAV after SARS-CoV-2 vaccination in a patient with AAV susceptible HLA-DRB1∗09:01 allele. (Table Presented).