Adult-Onset Still’s Disease following Coronavirus 2 (SARS-CoV-2) Vaccination: A Case Report

Abstract

In recent years, during the ravages of COVID-19, a variety of vaccines have been developed and are now on the market. However, although these new vaccines have undergone various trials, there are still many unknown side effects. We report a case of a 30-year-old woman who presented with general weakness, sore throat, generalized skin rashes, symmetrical arthralgia, and persistent fever of up to 40 °C with onset 16 days after receiving the Moderna COVID-19 vaccine. Adult-onset Still’s disease (AOSD) was diagnosed according to Yamaguchi’s criteria after excluding the feasibility of infectious diseases, autoimmune diseases, and malignancies. In particular, her responses to glucocorticoids and naproxen were significant and inversely proportional to her use of empirical antibiotics in the initial stage of treatment. We studied some similar cases of AOSD, which also considered the adverse effects of COVID-19 vaccination and suggested the immunogenicity and possibility of inflammatory responses related to COVID-19 vaccination.

New-Onset Rheumatic Immune-Mediated Inflammatory Diseases Following SARS-CoV-2 Vaccinations until May 2023: A Systematic Review

“…All 22 patients with adult-onset stills disease (ASOD) had a fever as a presenting complaint [7,74,[87][88][89][90]92,95,99,118,119,159,171,186]. Although characteristic salmon-pink skin rashes were also a common presenting feature along with arthralgia/arthritis, it was a delayed presenting feature in five patients [74,[87][88][89]118].…”

Insights into new-onset autoimmune diseases after COVID-19 vaccination

“…Adult-onset Still’s disease (AOSD) is a rare auto-inflammatory disorder of unknown etiology characterized by a high spiking fever, arthralgia, evanescent rash, and striking leucocytosis with neutrophilia [ 95 ]. A total of twenty-two cases of new-onset AOSD were reported in patients presenting with macroscopic hematuria following COVID-19 vaccination, with a male-to-female ratio of 4:7 [ [96] , [97] , [98] , [99] , [100] , [101] , [102] , [103] , [104] , [105] , [106] , [107] , [108] , [109] , [110] ]. Ten cases were reported following the mRNA vaccine, with five after the second dose, and the remainder following the viral vector vaccination, with one case reported after the second dose.…”

Associations of HLA Polymorphisms with Anti-SARS-CoV-2 Spike and Neutralizing Antibody Titers in Japanese Rheumatoid Arthritis Patients Vaccinated with BNT162b2

“…Although haplotype and two-locus analyses suggested the primary role of DRB1 alleles, other genes in linkage disequilibrium with DRB1 - DQB1 loci might also increase the production of anti-SARS-CoV-2 Abs. Adult-onset Still’s disease was associated with DRB1*12:01 and DRB1*15:01 in Japanese populations [ 26 , 27 ]; several patients with adult-onset Still’s disease after being vaccinated against SARS-CoV-2 were reported [ 28 , 29 , 30 ]. It was known that drug-induced adverse effects are common in adult-onset Still’s disease.…”