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

Abstract

Patient: Male, 68-year-old Final Diagnosis: Segmental arterial mediolysis Symptoms: Abdominal pain Medication:— Clinical Procedure: — Specialty: General and Internal Medicine Objective: Unusual clinical course 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.

Molecular Mechanisms of Pathogenesis, Prevention, and Therapy of COVID-19: Summarizing the Results of 2021

“…In this context, the most recent variant of SARS-CoV-2 "Omicron" has raised global concerns and alarm by virtue of a large number of mutations in the spike protein facilitating virus evasion of immune protection and reducing the efficacy of the existing vaccines [4]. There are other problems that are faced in the use of different types of vaccines, such as the possibility of antibody-dependent enhancement (ADE) of viral infection [5], decrease in the effectiveness of live attenuated vaccines in the presence of neutralizing antibodies [6]; and onset of vaccination-related complications in individual patients [7][8][9]. Moreover, according to some authors, the current policy of obligatory vaccination is scientifically questionable and is likely to do more harm to society than good [10].…”