Hyper-inflammation after COVID-19 mARN vaccination: at the crossroads of multisystem inflammatory disease and adult-onset Still’s disease. Does terminology matter?

Băicuș, Cristian; Delcea, Caterina; Pinte, Larisa; Dan, Gheorghe Andrei

doi:10.2478/rjim-2021-0035

Cited by 20 publications

(28 citation statements)

References 9 publications

(8 reference statements)

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“…Reports describing post-vaccine autoimmune phenomena, such as Guillain-Barre syndrome, thrombotic thrombocytopenia, myocarditis and hyper-inflammatory pathologies [12,13], in previously healthy individuals, increased the concerns regarding the risk of disease flare-up development.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Vaccine Does Not Increase the Risk of Disease Flare-Ups among Patients with Autoimmune and Immune-Mediated Diseases

Pinte

Negoi

et al. 2021

JPM

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Background: Reports describing post-vaccine autoimmune phenomena, in previously healthy individuals, increased the concerns regarding the risk of disease flare-ups in patients with immune diseases. We aimed to assess the potential risk of disease flare-up, after receiving the COVID-19 (Coronavirus disease 2019) vaccine, during a follow-up period of 6 months. Methods: We performed a prospective cohort study, enrolling the patients with autoimmune- and immune-mediated diseases who voluntarily completed our questionnaire, both online and during hospital evaluations. Based on their decision to receive the vaccine, the patients were divided into two groups (vaccinated and non-vaccinated). Participants who chose not to receive the vaccine served as a control group in terms of flare-ups. Results: A total of 623 patients, 416 vaccinated and 207 non-vaccinated, were included in the study during hospital evaluations (222/623) and after online (401/623) enrolment. There was no difference concerning the risk of flare-up between vaccinated and non-vaccinated patients (1.16, versus 1.72 flare-ups/100 patients-months, p = 0.245). The flare-ups were associated with having more than one immune disease, and with a previous flare-up during the past year. Conclusions: We did not find an increased risk of flare-up following COVID-19 vaccination in patients with autoimmune-/immune-mediated diseases, after a median follow-up of 5.9 months. According to our results, there should not be an obvious reason for vaccine hesitancy among this category of patients.

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Section: Discussionmentioning

confidence: 99%

COVID-19 Vaccine Does Not Increase the Risk of Disease Flare-Ups among Patients with Autoimmune and Immune-Mediated Diseases

Pinte

Negoi

et al. 2021

JPM

Self Cite

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“…Another case of hyperinflammation described as an AOSD-like form (Yamaguchi’s criteria fulfilled) was reported in Romania in a 22-year-old male with a past unremarkable history. 2 Thirteen days after receiving the first shot of BNT162b2 vaccine, he started to complain fever associated with sore throat, myalgias, maculopapular rash and elevated inflammatory markers; because of an acute chest pain and an initial myocardial dysfunction (high troponin, ST elevation at electrocardiogram (ECG), and left ventricular hypokinesia), he was hospitalized. After the exclusion of infections, major neoplasia and autoimmune conditions he started broad spectrum antibiotics without amelioration; thus, i.v.…”

Section: Case Seriesmentioning

confidence: 99%

“…Because of high ferritin levels, the persistence of inflammatory symptoms, the new onset of arthralgias in the large joints, and despite the high dose of glucocorticoids, he started s.c. anakinra 100 mg every other day and then every 2 and 3 days (due to supply issues) with a progressive improvement of inflammatory markers, leading to a general decrease in glucocorticoids daily intake. 2…”

Section: Case Seriesmentioning

confidence: 99%

See 1 more Smart Citation

Hyperinflammation after anti-SARS-CoV-2 mRNA/DNA vaccines successfully treated with anakinra: Case series and literature review

Bindoli

Giollo

Galozzi

et al. 2022

Exp Biol Med (Maywood)

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The current SARS-CoV-2 pandemic diffused worldwide has encouraged the rapid development of vaccines to counter the spread of the virus. At present in Italy, 75.01% of the population completed the vaccination course (AIFA.gov.it) and very few adverse events have been recorded by now. Side-effects related to a theoretical over-reaction of the immune system in response to vaccines administration have been described, and the possibility that an autoimmune or a hyperinflammatory condition may occur was recently observed. Herein, we report four cases of hyperinflammatory syndrome with features indicative of Adult-onset Still’s disease (AOSD) and macrophage activation syndrome (MAS), occurred after anti-SARS-CoV-2 vaccine injection and seen at our Unit between March and May 2021. Since interleukin (IL)-1 is one of the pivotal cytokines involved in AOSD pathogenesis, the inhibition of IL-1 is crucial in ameliorating the clinical symptoms of those patients. Moreover, it has been highlighted the central role of IL-1 as a hallmark of the hyperinflammatory status elicited by SARS-CoV-2 infection. In this case series, we successfully employed the IL-1 receptor antagonist anakinra to curb the cytokine release likely unleashed by the vaccine stimulation in potentially predisposed subjects. We also made a literature search to detect other patients with hyperinflammation temporally related to vaccines injection who benefited from IL-1 inhibition, while other AOSD/MAS-like described syndromes improved with other immunomodulatory strategies.

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“…Theoretically, an innovative vaccine of COVID-19 may behave like an adjuvant, resulting in perturbations in immune system, acting as a potential trigger for AOSD. As of concern, several cases of flares of other AIAIDs [9,35] or new diagnoses of AOSD due to COVID-19 vaccination have been reported [12][13][14][15][16]. On the other hand, to the best of our knowledge, there have been only two cases of flare up of AOSD reported following COVID-19 vaccination [10,11].…”

Section: Discussionmentioning

confidence: 99%

Flare of adult-onset Still’s disease following mRNA COVID-19 vaccination: a case report and review of literature

et al. 2022

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The upheaval caused by the coronavirus disease 2019 (COVID-19) pandemic has allowed to large population to use new vaccines urgently. Although vaccine development programs and available epidemiological data reassure us, there are concerns about specific risks associated with vaccinations in patients with autoimmune-autoinflammatory diseases. These patients have the potential to decrease humoral and cellular immune responses caused by biologic agents and develop an acute flare of underlying disease following vaccination. We herein present a rare case of a 49-year-old female with a flare of adult-onset Still’s disease (AOSD) after the first dose of BNT162b2 mRNA COVID-19 vaccination. She had been diagnosed with AOSD 7 years earlier and had achieved remission with tocilizumab. This patient came to the emergency room with fever and nausea that occurred 4 days after the first vaccination. Based on laboratory results and clinical manifestations, we suspected AOSD flare and was treated with steroid pulse therapy. In this report, we also discuss possible mechanisms linking vaccination with a flare of AOSD. Considering the close time relationship between COVID-19 vaccinations and a flare of AOSD, physicians should be aware of adverse events from this new vaccination and evaluate the benefits and risks of vaccination for each patient. Key Points • COVID-19 vaccination may cause an AOSD flare in patients who are in remission with tocilizumab.

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Hyper-inflammation after COVID-19 mARN vaccination: at the crossroads of multisystem inflammatory disease and adult-onset Still’s disease. Does terminology matter?

Cited by 20 publications

References 9 publications

COVID-19 Vaccine Does Not Increase the Risk of Disease Flare-Ups among Patients with Autoimmune and Immune-Mediated Diseases

COVID-19 Vaccine Does Not Increase the Risk of Disease Flare-Ups among Patients with Autoimmune and Immune-Mediated Diseases

Hyperinflammation after anti-SARS-CoV-2 mRNA/DNA vaccines successfully treated with anakinra: Case series and literature review

Flare of adult-onset Still’s disease following mRNA COVID-19 vaccination: a case report and review of literature

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