DYSPNEIC AFTER EVERY COVID-19 SHOT: SUSPECTED BNT162B2 MRNA VACCINE-RELATED, DRUG-INDUCED PULMONARY EOSINOPHILIA
Chest
; 162(4):A2190, 2022.
Article
in English
| EMBASE | ID: covidwho-2060909
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:
Eosinophilia is the most commonly reported adverse event following administration of the Pfizer/BioNTech vaccine, accounting for 237 of 372 events (63.7%). Eosinophilic pneumonia has been described noted in 3 of all reported cases. CASE PRESENTATION We present the case of a 73 year-old male presented to his PCP with a 3 week history of nonproductive cough and wheezing. He completed a 2-shot series of BNT162b2 mRNA (Pfizer/BioNTech) COVID vaccine 1 week prior to symptom onset. He had no history of respiratory symptoms, smoking, sick contacts, recent travel, chemical or biological exposures. On presentation, he was afebrile, tachycardic and required 3LPM supplemental oxygen to maintain peripheral oxygen saturation (SpO2) above 94%. Laboratory findings noted leukocytosis (13,200/mL) and eosinophilia at 5% (Absolute Eosinophil Count (AEC) 580 cells/L). Respiratory viral panel, procalcitonin, ESR and D-dimer were negative. Chest CT scan was unremarkable. He was treated with azithromycin, prednisone and inhaled bronchodilators with improvement in hypoxia. 2 weeks later, he reported intermittent dyspnea during a pulmonary clinic visit. Pulmonary function testing was normal (FEV1/FVC 76%;FVC 3.67L (90% predicted);FEV1 2.80L (88% predicted). IgE level was normal and eosinophilia had resolved. 6 months after initial symptom onset, the patient received his third BNT162b2 mRNA vaccine dose. 2 weeks after vaccination, he presented to the ED with severe dyspnea, wheezing and cough with yellow sputum. He also noted a new itchy, erythematous bilateral forearm rash and painless oral ulcers. On exam, he was afebrile, tachypneic with SpO2 of 93% on 4LPM supplemental oxygen and audibly wheezing with a prolonged expiratory phase. Laboratory studies noted elevated creatinine and leukocytosis (23,100/mL) with marked eosinophilia (29.5 %, AEC 6814 cells/L). Chest CT scan revealed a 2 cm rounded ground-glass opacity in the right upper lobe. (Figure 1.) Further workup revealed a weakly positive antihistone antibody (14 titer). IgE, ANA, ANCA, SS-A/B, anti-CCP, and complement levels were normal. Intravenous methylprednisolone treatment was initiated with rapid improvement in dyspnea, eosinophilia and renal function. A transbronchial biopsy (Figure 2.) of the RUL lung lesion revealed organizing pneumonia with mixed inflammatory infiltrate. Bronchoalveolar lavage analysis revealed elevated WBC (432 cells/L) with neutrophilic predominance (85%). Patient was discharged home on a prednisone taper with resolution of symptoms.DISCUSSION:
Subsequent allergy work up did not indicate any apparent etiology of hypereosinophilia. Testing for strongyloides, coccidiosis and aspergillosis were also negative. A final diagnosis of BNT162b2 mRNA vaccine related pulmonary eosinophilia was made.CONCLUSIONS:
Additional study is warranted into eosinophilic disease associated with the BNT162b2 mRNA vaccine. Reference #1 1. United States Department of Health and Human Services (DHHS), Public Health Service (PHS), Centers for Disease Control (CDC) / Food and Drug Administration (FDA), Vaccine Adverse Event Reporting System (VAERS) 1990 - 03/11/2022, CDC WONDER On-line Database. Accessed at http//wonder.cdc.gov/vaers.html on Mar 11, 2022 11837 PM DISCLOSURES No relevant relationships by Matthew Haltom No relevant relationships by Nikky Keer No relevant relationships by Thekrayat Khader No relevant relationships by Muthiah Muthiah
azithromycin; bronchodilating agent; creatinine; cyclic citrullinated peptide antibody; D dimer; endogenous compound; histone antibody; immunoglobulin E; messenger RNA; methylprednisolone; neutrophil cytoplasmic antibody; oxygen; prednisone; procalcitonin; RNA vaccine; tozinameran; aged; allergy; aspergillosis; case report; clinical article; coccidiosis; conference abstract; coronavirus disease 2019; coughing; diagnosis; disease control; drug combination; drug therapy; drug toxicity; dry cough; dyspnea; eosinophil count; eosinophilia; Food and Drug Administration; forced expiratory volume; forced vital capacity; forearm; gene expression; ground glass opacity; hospital discharge; human; human cell; hypereosinophilia; hypoxia; immunoglobulin blood level; inflammatory infiltrate; intravenous drug administration; kidney function; leukocytosis; Loeffler pneumonia; lung function; lung lavage; male; mixed cell culture; mouth ulcer; multicenter study; neutrophil; nonhuman; organizing pneumonia; oxygen saturation; public health service; rash; side effect; smoking; sputum; Strongyloides; tachycardia; thorax; tissue oxygenation; transbronchial biopsy; travel; United States; vaccination; wheezing; x-ray computed tomography
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Topics:
Vaccines
Language:
English
Journal:
Chest
Year:
2022
Document Type:
Article
Similar
MEDLINE
...
LILACS
LIS