ABSTRACT
Laboratory tests revealed slight elevations in C-reactive protein level (1.60 mg/dL;normal, ≤0.30 mg/dL), erythrocyte sedimentation rate (22 mm/h;normal, ≤11 mg/dL), and serum ferritin (1083 ng/mL;normal, ≤114 ng/mL) with a normal white blood cell count. Serological examinations for autoimmune diseases (e.g., antinuclear antibody, rheumatoid factor, anticyclic citrullinated peptide-antibody, anti-double-stranded DNA-antibody, anti-Smith antibody, anti-aminoacyl tRNA synthetase-antibody, anti-Mi-2-antibody, anti-transcriptional intermediary factor 1-γ-antibody, and anti-melanoma differentiation-associated gene 5-antibody) and infections (e.g., human immunodeficiency virus, hepatitis B virus, hepatitis C virus, parvovirus B19, syphilis, and Streptococcus) were negative. The etiology of AOSD is unclear;however, pathogen-associated- (PAMPs) or damage-associated molecular patterns may activate the immune system in genetically predisposed patients, 5 leading to interleukin (IL)-1β and IL-18 overproduction, known as a cytokine storm. 5 The SARS-CoV-2 spike proteins, envelope proteins, and viral RNA are potent PAMPs, whereas the nucleocapsid proteins can block IL-1β release. 1 The mRNA COVID-19 vaccines encode spike proteins but not nucleocapsid proteins, and thus may disturb the host immune system.