ABSTRACT
Background: Vaccinations are of paramount importance in eradicating various diseases. Currently, there have been numerous reports on the development of new-onset autoimmune phenomena and disease flares following COVID-19 vaccination. The etiology and vaccine trigger mechanism of autoimmune disease still remains unclear. Molecular mimicry, by-stander activation and role of vaccine adjuvants are the main pathogenic mechanisms linked to an autoimmune phenomenon. However, vaccines as inducers of an autoimmunity is still an arguable subject. Case: We report a case series of six patients who developed new onset autoimmune reaction and disease flares following SARS-COV 2 vaccine. The patients received viral vector vaccine, inactivated vaccine and mRNA vaccine who developed symptoms in an average of 7-28 days following inoculation. A 27 year old male, previously healthy developed new onset of clinical amyopathic dermatomyositis after a week of 1st and 2nd dose of a viral vector vaccine. Two patients with systemic lupus erythematous developed severe cutaneous, hematologic and renal flare 14 and 28 days following vaccination. Two rheumatoid arthritis patients in long remission, developed atypical arthritis and disease flares after 10 and 14 days of inactivated and mRNA vaccine inoculation. One patient with spondylarthritis in remission experienced disease flare 7 days following inactivated SARS-COV- 2 vaccination. The patient age ranges from 19-72 years old of whom two are males and four are females. The management was individualized which includes oral corticosteroid and disease modifying anti-rheumatic drugs which showed improvement of symptoms. Conclusion: Development of an autoimmune reaction following SARS-COV 2 vaccination is of scientific and public importance. Vaccination might potentially trigger an autoimmune disease, however further investigations need to be established. The causative link between vaccination and autoimmunity needs to be studied. Susceptibility to a vaccine-induced autoimmunity might be triggered by the individual's genetic predisposition and several pathomechanisms.
ABSTRACT
Objective: To present a case of seronegative oligo-arthritis following COVID-19 infection. Background(s): COVID-19 infection caused by SARS-CoV- 2 may induce autoimmune phenomena. Although musculoskeletal symptoms are usual in COVID-19 infections, clinical arthritis with signs of inflammation are relatively uncommon. Our case highlights the occurrence of reactive arthritis following a COVID-19 infection. Case: A 37 year old woman developed sore throat, rashes, erythema and painful swelling of the 3rd distal interphalangeal joint of the hand and 1st metatarsophalangeal joint of the right foot following COVID-19 exposure. Nasopharyngeal swab test for SARS-CoV- 2 infection was positive. She had completed COVID-19 (inactivated Sinovac) vaccine 2 months earlier. There was a history of undifferentiated inflammatory arthritis 2 years earlier which had resolved with few months of methotrexate and non-steroidal anti-inflammatory drugs (NSAIDs). Work-up disclosed normal complete blood count and erythrocyte sedimentation rate (ESR), slightly elevated C-reactive protein;rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) were negative. She took NSAID for arthritis and anti-histamine for rashes and completed home-based quarantine. Symptoms resolved over the subsequent 2 to 3 weeks without sequelae. Conclusion(s): This case illustrates an autoimmune reaction to COVID-19 infection in the form of reactive arthritis (ReA). Although the clinical presentation, pathomechanisms, and management are likely similar to those described for ReA, we explore additional insights into other mechanisms and manifestations unique to post COVID-19 infections, and the increased susceptibility of this patient with prior history of undifferentiated inflammatory arthritis.
ABSTRACT
Background: Autoimmune inflammatory rheumatic diseases (AIRD) were associated with an increased risk for COVID-19 infection, worse clinical outcomes, and COVID-19- related deaths. Vaccines carry the potential benefit of reducing disease transmission and disease severity. Issues on vaccine safety, trigger of an autoimmune reaction or disease flares has been a long issue. Thus this study describes the COVID-19 vaccination status and adverse events following SARS-COV 2 vaccine in a tertiary hospital in Manila, Philippines. Method(s): This retrospective cross-sectional study included patients diagnosed with AIRD and seen in the clinics over 12 months (March 2021-March 2022).We collected data from patients' clinic records and analyzed the clinicodemographic profile, vaccination status, adverse events and development of new onset autoimmune reaction and disease flares post vaccination and those who developed COVID-19 infection even after vaccination. Result(s): There were 204 respondents included in this study: 174 (85%) were female and 30 (14%) were male;63.2 % with SLE, 10.8% rheumatoid arthritis, 8.3% psoriatic arthritis, 6.4% ankylosing spondylitis and other systemic autoimmune disease. Others included were scleroderma and inflammatory arthritis and myopathies. The median age is 38.4 years. 100% of the respondents were fully vaccinated;87 (42.6%) received inactivated vaccine, 63 (30.8%) viral vector vaccine and 54 (26.4%) mRNA vaccine. 133 (65.2%) reported no adverse events while 71 (34.8%) experienced constitutional symptoms, musculoskeletal, cutaneous, respiratory, gastrointestinal and cardiovascular symptoms after vaccination. There were 9 (4.4%) of the respondents who developed new onset autoimmune reaction and disease flares 7-28 days post vaccination;1 patient had new onset amyopathic dermatomyositis;3 SLE patients developed severe hematologic, cutaneous and renal flare;2 rheumatoid arthritis, 1 spondyloarthritis, and 1 inflammatory arthritis patients in long remission had disease flares and 1 patient with henoch schonlein purpura developed flare. Twenty two (10.8%)of the respondents developed COVID-19 infection after 30-120 days post vaccination;19 (86.4%) had mild symptoms, 2 (9.1%) moderate infection and 1 (4.5%) had severe infection and all of the patients recovered. Conclusion(s): This study showed that patients with AIRD experienced varied organ system adverse events following vaccination ranging from mild side effects, disease flares and new onset autoimmune reactions. The development of an autoimmune reaction following SARS-COV 2 vaccination is of scientific and public importance and still needs to be investigated. Even after a complete vaccination, some patients still had COVID-19 infection, however preventing them from worse complications, hospitalization and mortality.
ABSTRACT
Objective: We report the complicated and challenging case of a lupus nephritis patient on treatment for multi-drug resistant disseminated tuberculosis who developed severe COVID-19 infection. Case: A 24-year-old female diagnosed with SLE nephritis maintained on mycophenolate mofetil (MMF), hydroxychloroquine (HCQ) and a calcineurin inhibitor (CNI) developed disseminated multidrug resistant tuberculosis (MDR-TB) involving the lungs, liver and lymph nodes. She was started on anti-TB regimen in addition to high dose prednisone, whereas MMF and CNI were discontinued. In the course of anti-TB treatment, adverse drug reactions to MDR-TB included QT prolongation also prompting the discontinuation of HCQ. On the 10th month of treatment with clofazimine, cycloserine, paminosalicylic acid, and delamanid, she developed fever, dyspnea, chest pain, disorientation accompanied by progressive oxygen desaturation. Nasopharyngeal swab for SARS-CoV-2 RT-PCR test was positive, high resolution chest CT (HRCT) showed new peripheral ground-glass opacities consistent with COVID-19 pneumonia. Oxygen support with high-flow nasal cannula at 60% FiO2, low molecular weight heparin, meropenem, remdesivir, and dexamethasone were given;MDR-TB treatment was temporarily withheld. The patient recovered after 3 weeks hospitalization and MDR-TB treatment was resumed following hospital discharge. Conclusion: This case illustrates the management challenges in a lupus nephritis patient with disseminated TB who developed and eventually recovered from severe COVID-19 infection.