COVID-19 vaccine-associated autoimmune inflammatory rheumatic diseases

Background/Purpose: Vaccination against the most recently COVID-19 is one of the critical tools to provide herd immunity, reduce mortality, and control the pandemic worldwide. Despite the immense benefits of vaccination, an occasional association between vaccination and autoimmunity induction has been detected in human subjects. The current study presented fourteen cases of autoimmune rheumatic diseases (ARDs) following various COVID-19 vaccines. Method(s): This observational two-center study was conducted in the rheumatology clinics of the Connective Tissue Diseases Research Center at Tabriz University of Medical Sciences and Kashan University of Medical Sciences. All patients were referred to clinics with ARDs symptoms after implementing the COVID-19 vaccination program in Iran from April 2021 and were considered for enrollment in the study. Inclusion criteria were the onset of ARDs symptoms at four weeks post-vaccination, age >=16, no previous history of ARDs, meeting the classification criteria of one of the ARDs, and staying in the follow-up. Result(s): Between April 2021 and January 2022, 22 adult patients with symptoms of ARDs after COVID-19 vaccination were considered for eligibility. Eventually, 14 patients were diagnosed with ARDs based on classification criteria, and whose symptoms had started within four weeks after vaccination were included in the study. The duration of follow-up was 2-10 months. The vaccines used in these patients were Sinopharm [7 cases (50%)], AstraZeneca [6 cases (42.9%)], and COVIran Barakat [1 case (7.1%)]. It should be noted that vaccines that have been used for public vaccination in Iran until January 2022 were Sinopharm (78.9%), AstraZeneca (11.7%), and COVIran Barekat (8.1%), and Sputnik (1.3%). Crosstabulaton analysis showed that ARD was significantly more common in subjects who received AstraZenca vaccine than in subjects who received other vaccines (P < 0.001). Based on the results, the involved patients were diagnosed with RA or one of its subtypes (five cases), vasculitis (four cases), SLE (three cases), and peripheral SpA (pSpA) (two cases). In eleven cases, symptoms started two weeks after vaccination. However, diagnosis in eight patients was delayed for more than four weeks. Except for one patient with self-limitation of ARD, others required treatment with anti-inflammatory drugs and disease-modifying antirheumatic drugs, which even one of them developed irreversible neurological complications. Conclusion(s): Indeed, our data can warn physicians about the possibility of ARDs post-vaccination, lead to faster diagnosis, prevent loss of window of opportunity for treatment, and prevent irreversible organ damages.

Immune-mediated necrotizing myopathy following vaccination with the AstraZeneca (AZD1222) COVID-19 vaccine: A case report and brief review.

Immune-Mediated Necrotizing Myopathy (IMNM) after vaccination has been reported previously, however it is rare after COVID-19 vaccination. We report the first case of IMNM two weeks after vaccination with the AstraZeneca (AZD1222) COVID-19 vaccine. There was a probable temporal relationship between the COVID-19 vaccination and the development of IMNM due to lack of known causative factors for IMNM. This may have been due to 1) autoimmunity directly caused by the vaccine, 2) exacerbation of autoimmunity triggered by the vaccine or 3) autoimmune syndrome triggered by the vaccine adjutants. Further studies are needed to assess the underlying mechanisms.

Status epilepticus due to COVID-19;a cases series and literature review

Complications are increasingly recognized with SARS-CoV-2, the causative pathogen for COVID-19. Various mechanisms have been proposed to justify the cause of seizures in Covid-19 patients. To our knowledge, 13 cases of status epilepticus (SE) associated with COVID-19 have been reported so far. Here, we present a single-center case series, including the clinical, laboratory, and imaging characteristics, and the EEG and the outcome of SE in 5 Iranian patients with laboratory-confirmed SARS-CoV-2 virus. SE was para-infectious in four patients and post-infectious in one other patient. In Three patients, the causes of seizure were included severe hyponatremia, acute ischemic stroke, and meningoencephalitis. However, in two other patients, no specific reason for seizure was found, but there are possibilities for lesser-known mechanisms of Covid-19 that play roles in developing SE. Two of the patients recovered, and three patients, older and with higher comorbidities, failed to recover and died.

Subtle Neurological Symptoms as Early Signs of Watershed Infarction in COVID-19 Infection

Objective: In this study we aimed to evaluate the clinical and imaging characteristics of a cohort of COVID-19 patients with stroke. Background: Cerebrovascular diseases comprise a significant portion of neurological disorders related to COVID-19. Design/Methods: In this cross-sectional study, ninety-five COVID-19 patients with stroke were included between October 2020 and January 2021. Patients were evaluated based on the following clinical and imaging features: severity of COVID-19 (critical/non-critical), stroke type, presence or absence of clinical suspicion of stroke (suspicious/non-suspicious), medical risk factors, Fazekas scale, ASCOD criteria classification, and presence or absence of watershed infarction. Clinical outcomes were assessed based on Modified Rankin Scale (MRS) and mortality (during hospitalization and within three months of discharge). Chi-square test, independent t-test, and one-way ANOVA were used to compare variables. Multivariable logistic regression was applied to evaluate the effects of relevant factors on the likelihood that participants have watershed infarction. Results: Ischemic stroke (n=79, 83.1%) and intracerebral hemorrhage (n=7, 7.4%) were the most prevalent types of stroke. According to ASCOD classification, most common causes of ischemic stroke were cardioembolic (n=21, 26.6%) or other determined causes (n=18, 22.8%). Watershed infarction was the most common etiology among other determined causes (16/18, 88.9%). Watershed infarction was significantly associated with being clinically non-suspicious (OR=8.46, p<0.001) and death after discharge (OR=12, p<0.001). Patients with watershed infarction had a higher odds of having a high Fazekas score (OR=6.42, p=0.002) which was confirmed by logistic regression model (adjusted OR=26.1, p=0.006). Conclusions: Watershed infarct is one of the common causes of Ischemic stroke in COVID-19 patients, which should be considered in patients with critical COVID-19 and those without obvious clinical symptoms of stroke. Patients with chronic small vessel disease are more susceptible to watershed infarctions. Early neuroimaging can play an important role to better identify these patients.