CYTOMEGALOVIRUS PROCTITIS DEVELOPING AFTER CORONAVIRUS DISEASE 2019 (COVID-19) VACCINE: CAUSALITY OR CASUALTY?

ABSTRACT

AIM: The COVID-19 epidemic is still raging over the globe, and vaccination is supposed to help us overcome it. Although the vaccinations' efficacy is undeniable, their safety is still a concern. This is the first case of CMV proctitis following vaccination since the invention of the COVID-19 vaccine, suggesting that the COVID-19 vaccine may not only cause immune hyperactivity but also cause immune deficiency. We report this case to provoke new thinking about the safety of COVID-19 vaccines. METHODS: We described a case of a 58-year-old Chinese woman, without obvious cause of immunosuppression, who developed persistent constipation three days after the second COVID-19 vaccination. Electronic colonoscopy revealed new circumferential growth at the anorectal junction, with uneven surface and ulceration, which mimicked rectal carcinoma. Rectal biopsy revealed severe active chronic proctitis with CMV infection. The clinical course was favorable with ganciclovir therapy. In this case, we used laboratory biochemical examination, colonoscopy, immunohistochemistry, and other methods to detect, and finally confirmed the existence of CMV proctitis. RESULTS: Ganciclovir was used to treat the patient, and a good effect was observed. Cytomegalovirus (CMV) infection of the gastrointestinal tract occurs mainly in immunosuppressed patients. While in our case, there was no evidence of immunodeficiency, except for earlier vaccination against COVID-19. Therefore, it is plausible to doubt that COVID-19 vaccination caused the occurrence of CMV proctitis in the patient. CONCLUSIONS: It is speculated that the vaccine can cause immune dysfunction, and thus may not only lead to the occurrence of immune hyperactivity disorders but also immune deficient diseases. The clinical course of CMV proctitis was favorable with ganciclovir therapy.