A Case of Segmental Arterial Mediolysis of Multiple Visceral Arteries Following Anti-COVID-19 Vaccination: Late Complication or Rare Coincidence?

BACKGROUND Segmental arterial mediolysis (SAM) is a rare noninflammatory, nonatherosclerotic vascular disorder characterized by arterial media disruption. In conjunction with the SARS-CoV-2 infection or anti-COVID-19 vaccination, vascular disorders have been recognized as organ-specific immune-mediated complications, and the number of reported cases is gradually increasing. CASE REPORT A 68-year-old man presented with severe upper abdominal pain and nausea 58 days after a third injection of Pfizer-BioNTech anti-COVID-19 mRNA vaccination. An abdominal dynamic computed tomography angiography showed stenosis and dilatation of multiple visceral arteries, including the middle and right colic arteries. In the omental arteries, spindle-shaped dilatation and stenosis were identified. The left epiploic artery was not visualized, suggesting the development of occlusion due to arterial dissection. Based on these findings, SAM of multiple visceral arteries was diagnosed. Because the patient's vital condition was stable, treatment by observation, with restriction of daily living, was chosen. Seventy-five days later, the pathological lesions in the affected vessels spontaneously resolved. CONCLUSIONS While coincidence could not be completely excluded in this case, anti-COVID-19 mRNA vaccination should be noted for its potential association with SAM as a possible late complication.

Gasless laparoendoscopic single-site surgery for management of unruptured tubal pregnancy in a woman with moderate COVID-19 pneumonia after administration of remdesivir and casirivimab-imdevimab: A case report.

BACKGROUND: Diagnostic and therapeutic challenges may arise in the management of gynecologic emergencies, such as ectopic pregnancy, for women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. CASE: A 33-year-old woman (gravida 3, para 2) with a history of SARS-CoV-2 infection 8 months prior experienced sudden onset of fever and cough. Four days later, she consulted her gynecologist because of a positive pregnancy test and was further referred because of suspected ectopic pregnancy at 11 weeks of gestation, as calculated from her last irregular menstrual period. At triage, the patient complained of dyspnea, chest pain, and cough. Real-time reverse transcription-polymerase chain reaction assay detected SARS-CoV-2, which was subsequently identified to be an L452R variant. Chest computerized tomography (CT) showed moderate COVID-19 pneumonia. Transvaginal ultrasonography and pelvic CT showed a right tubal mass without an intrauterine gestational sac, suggesting right tubal pregnancy. Systemic methotrexate (MTX) therapy was chosen for management of the tubal pregnancy because of the patient's unruptured hemodynamically stable status, along with immediate administration of remdesivir and casirivimab-imdevimab to prevent worsening of the pneumonia. After failed MTX therapy, gasless laparoendoscopic single-site right salpingectomy was performed due to concern for tubal rupture. Four days after surgery, the patient was discharged from the hospital without subsequent complications. CONCLUSIONS: Laparoscopic surgery, preceded by anti-viral therapy for COVID-19, is a feasible option for the management of hemodynamically stable tubal pregnancy in a woman with moderate COVID-19 pneumonia.