COVID-19 VACCINE-RELATED PNEUMONITIS

ABSTRACT

SESSION TITLE Issues After COVID-19 Vaccination Case Posters SESSION TYPE Case Report Posters PRESENTED ON 10/19/2022 1245 pm - 0145 pm INTRODUCTION: Since 2020, SARS-CoV-2 virus has spread rapidly and endlessly throughout the world, being one of the worst pandemics that the world has ever seen. The BNT162b2 mRNA COVID-19 has an efficacy rate around 95% and ability to reduce disease severity, but also associated with numerous adverse reactions. Here we present a case of a Vaccine Induced Pneumonitis following a booster of the BNT162b2 vaccine. CASE PRESENTATION A 72-year-old female presented to the ED with 3-day history of cough and dyspnea after receiving the booster (3rd dose) Pfizer COVID-19 mRNA vaccine. On the second day following vaccination started to develop a non-productive cough, difficulty breathing, and later in the afternoon had several episodes of nausea, vomiting, and fever. Initial presentation to hospital concerning for community acquired pneumonia, and patient was started on IV fluids and empiric antibiotics. However, after initial treatment respiratory condition worsened drastically concerning for iatrogenic pulmonary edema. Patient received diuretics but still failed to improve respiratory condition. CT chest revealed bil ground-glass opacities. Microbiologic and serologic testing negative, except for positive ANA. As the patient's condition failed to improve still on heated high flow O2, the patient underwent bronchoscopy which revealed diffuse erythematous with copious, thick, whitish mucus plugging airways. BAL cell count showed WBC 204 /cumm with lymphocytic predominance. BAL cultures were only positive for candida albicans in 1/2 pooled samples. Silver stain negative for P. jirovecii. After a negative infectious workup, the patient was started on systemic steroid therapy and her symptoms improved in two days. After five days of treatment, the patient was able to be discharged home with oxygen therapy on 1 L/min along with a steroid taper. DISCUSSION: Although there was likely a component of iatrogenic fluid overload from IV hydration, the patient's clinical condition did not improve even after vigorous diuresis. Patient does not have any significant underlying pulmonary disease, or CT/PFTs in past. Extensive infectious and autoimmune workup has been negative. Based on the GGO distribution, clinical course including symptoms after exposure to COVID-19 booster, and improvement after steroids, BAL cell count with lymphocytic predominance, we consider vaccine-induced interstitial lung disease as the most probable diagnosis. CONCLUSIONS: Our case highlights challenges in managing patients with airspace disease in the era of COVID-19 and vaccination. We would like to share a possible case of vaccination-induced interstitial lung disease. Our conclusion was made after ruling out the most common infectious and noninfectious causes and after having a favorable response to steroids. Reference #1 Influenza vaccine-induced interstitial lung disease. Watanabe et al. European Respiratory Journal Feb 2013, 41 (2) 474-477;DOI 10.1183/09031936.00146912 Reference #2 COVID-19 vaccine induced interstitial lung disease, Yoshifuji et al, Journal of Infection and Chemotherapy, 2021 Reference #3 COVID-19 mRNA Vaccine-induced Pneumonitis A Case Report. Internal Medicine, Japanese Society of Internal Medicine. Matsuzaki S et al., Released October 26, 2021 DISCLOSURES No relevant relationships by Harold Cedeno No relevant relationships by Chengtin Tseng