COVID-19 Vaccination as a Potential Trigger for New-Onset Systemic Lupus Erythematosus

Abstract

Immune hyperactivation has been linked to various vaccines. We present a potential association of newonset systemic lupus erythematosus (SLE) post-COVID-19 immunization. The patient is a 54-year-old male admitted for evaluation of flu-like symptoms two weeks after receiving the second dose of the COVID-19 vaccine. Physical examination revealed high-grade fever, diffuse bilateral non-tender cervical lymphadenopathy, and erythematous maculopapular palpable purpuric lesions on bilateral feet. Laboratory evaluation showed a significant hypocomplementemia (C3 < 11 mg/dL, C4 < 3 mg/dL, and CH50 < 10 U/mL), high titer antinuclear antibody, anti-dsDNA antibodies, anti-Sjogren's syndrome-related antigen A antibodies, anti-Sjogren's syndrome-related antigen B antibodies, anti-Smith antibodies, antiribonucleoprotein antibodies, anti-histone antibodies with a negative malignancy, and infection workup. The patient was treated with a high dose of steroids with a positive response. This case highlights the possibility of SLE, a rare adverse event following COVID-19 vaccination.

Systemic lupus erythematosus in the light of the COVID-19 pandemic: infection, vaccination, and impact on disease management

“…Other studies from India [ 44 ], Mexico [ 45 ], the EU [ 41 , 46 , 47 ], and the USA [ 48 , 49 ] reported similar results with local pain, headache, and fatigue being the most common adverse effects of different COVID-19 vaccines (Table 2 ). Severe reactions were noted in 0–1.8% across various studies [ 43 , 44 , 51 ]. The EULAR Coronavirus Vaccine (COVAX) physician-reported registry has examined vaccine-related adverse events in 5121 patients, including 369 with SLE.…”

“…Lupus symptoms were seen predominantly with B162b2/PfizerBioNTech (8 of 10) after either of the doses. Most patients were treated with GC along with steroid-sparing drugs, and all patients improved in the short term (Table 3 ) [ 51 – 60 ].…”

“…Most patients were treated with GC along with steroid-sparing drugs, and all patients improved in the short term (Table 3 ) [ 51 – 60 ].…”

Autoimmune and autoinflammatory conditions after COVID-19 vaccination. New case reports and updated literature review

“…Although widespread vaccination against COVID-19 has reduced disease severity and mortality, vaccine-related adverse events such as autoimmune and autoinflammatory diseases have been documented. These include thrombotic thrombocytopenia, myocarditis, Guillain-Barré syndrome (GBS), demyelinating disorders, and systemic lupus erythematosus (SLE), among others [ [9] , [10] , [11] , [12] , [13] , [14] , [15] ]. We present six new patients who experienced relapses of autoimmune diseases (AD) or developed a new autoimmune or autoinflammatory disease following vaccination.…”

Systemic lupus erythematosus following SARS-CoV-2 vaccination; a review of literature

“…There is a case report of a 54-year-old male who developed high-grade fever, cervical lymphadenopathy, and palpable purpuric lesions on his feet that, two weeks after receiving the second dose of the Pfizer COVID-19 vaccine (23).…”