ABSTRACT
With the onset of the global pandemic due to the new virus SARS-CoV-2 and the development of vaccines against it, various adverse events have been reported to them. We present a clinical case of a 53-year-old Caucasian woman who presented one week after Pfizer vaccination against SARS-CoV-2 with severe muscle weakness, myalgia in upper and lower extremities, alopecia 2 cm in diameter, and two mucosal ulcerations on lower lip. No deviations from the hematological, biochemical and immunological indicators were found from the laboratory tests carried out. Two weeks later, the patient developed total alopecia on the scalp. Due to the causal relationship with the administered vaccine, the patient was not given a second dose and a diagnosis of Systemic Connective Tissue Disease was not accepted. Six months later, recovery and partial hair growth was observed in the affected areas of the capillitium. Alopecia areata is autoimmune in nature, with literature reporting initial or recurrent alopecia after vaccination. It is important that adverse events after vaccination are properly evaluated in order to choose a proper therapeutic approach. © 2022 Medical Information Center. All rights reserved.
ABSTRACT
The onset of the pandemic caused by the new coronavirus has raised many questions in the global rheumatology society regarding the clinical course of the disease, effectiveness and complications of SARS-SoV-2 vaccination. The aim of this review is to analyze the information available up to date on the course of COVID-19 in patients with autoimmune rheumatic diseases (ARD), the frequency of complications in these patients, the effectiveness and side effects of vaccination against COVID-19. Various studies in Europe and the United States have found that the risk of severe COVID-19 in patients with ARD is similar to that in the general population. Negative prognostic factors are thought to be old age, comorbidity, moderate/high ARD activity, and corticosteroid (CS) intake at doses > 10 mg/day. Patients with systemic ARD are considered to be at higher risk of thromboembolic events due to chronic inflammation and/or the presence of antiphospholipid syndrome, as well as the nature of COVID-19 - an endothelial lesion causing thrombosis and microangiopathy. It is observed a higher risk of severe pneumonia in patients treated with Rituximab, as well as an increase in hospitalizations and deaths amongst them. The opposite trend is observed in patients treated with anti-TNF. With the development of vaccines against COVID-19, questions arise about their effectiveness in patients with ARD, as well as the frequency of complications associated with them. In these studies, slightly lower levels of neutralizing antibodies were observed in patients with ARD compared to the general population, most commonly associated with Methotrexate or targeted synthetic DMARDs. The most common side effects seen in these patients after vaccination are pain at the injection site, fatigue and headache. Complaints of the musculoskeletal system are more common in patients with ARD than in the general population. Exacerbations of the underlying disease following vaccination, requiring hospitalization, are rare. © 2021 Medical Information Center. All rights reserved.
ABSTRACT
Adult onset Still disease (AOSD) is a rare systemic autoinflammatory disease with poorly understood etiology that features quotidian fevers, polyarthritis and distinctive salmon-colored maculopapular rash. Extremely high levels of ferritin are seen in most patients, making it an important laboratory test for diagnosis. AOSD is a crucial diagnostic and therapeutic problem, which in many cases remains unrecognized due to the rarity in the population and the diverse clinical features. We preset to you a clinical case of a 34-year old woman with a first manifestation-maculopapular rash on the dorsal surface of the wrist joints and on the knee joints. At this time the patient had her firsttime pregnancy in the 6th gestational week. During a gynecological examination, intrauterine fetal death was found, which necessitated premature termination of pregnancy in the 8th gestational week. At the same time the patient was subfebrile and a couple of days later she reported fever up to 39°C. Even though the prescribed antibiotics combination, the patient had persistent fever episodes with shivering and tendency to increasing acute phase reactants. The woman was hospitalized in a Clinic of Nephrology in an impaired general condition, where a combination of antibiotic and corticosteroid therapy was performed with unsatisfactory effect. She performed two PCR-tests for Sars-Cov-2 infection and both results were negative. Microbiological culture tests for bacterial, viral and mycotic infections have shown an increased IgG-antibody titer for Brucelosis. An active Brucella infection was confirmed by a positive PCR-test at a Clinic in Infectious Diseases. A two-month antibiotic course with Doxycycline 200 mg/daily was prescribed, but the fever persisted. The patient was hospitalized in the Clinic of Rheumatology with a fever of unknown origin up to 39°C, polyarthralgia, polymyalgia, maculopapular rash on the chest, leukocytosis, thrombocytosis, increased LDH-, ferritin-, GGT-, acute phase reactant levels, microcyte hypochromic anaemia, negative immunological findings (anti-MCV, anti-CCP, ANA-screen, ANA-blot, anti-dsDNA, ANCA, anti-MPO, anti-PR3, aCL, anti-B2GPI, anti-Protrombin), negative Quantiferon. The patient was diagnosed with AOSD and started therapy with Methylprednisolone 60mg/daily, when she got persistent afebrile condition and significant improvement in the clinical status and laboratory parameters.