Isolated popliteal artery lesion due to giant cell vasculitis post COVID-19 mRNA vaccine and COVID-19 asymptomatic infection

Abstract

Objective Giant cell arteritis (GCA) is a rare granulomatous vasculitis, affecting medium and large vessels, usually in old patients. The incidence of GCA has been higher during current COVID-19 pandemia and COVID-19 is recognized for its immune dysregulation. Lower limbs involvement is uncommon but can be limb threatening, resulting in limb loss. Method A 43-year-old man presented with a sudden pain in his right calf and foot associated with pallor and hypothermia, and there was objective evidence of ischemia. Symptoms began few days after he received the first dose of a COVID-19 mRNA vaccine and COVID-19 asymptomatic infection 20 days after vaccination. He had no history of any signs of claudication pre-COVID or limb trauma and was very fit. Enhanced computed tomography and magnetic resonance imaging (MRI)suggest diagnosis of popliteal artery cystic adventitial disease. We resected the affected popliteal artery with interposition using a right great saphenous vein graft, through a posterior approach. On the fourth postoperative day, he was discharged. Histopathological examination revealed patchy intramural inflammatory infiltrates composed of lymphocytes and rare multinucleated giant cells at the internal lamina and adventitia consistent with a diagnosis of GCA. Conclusion and Result Our case represents the first reported case of isolated popliteal GCA following vaccination with a COVID-19 mRNA vaccine and COVID-19 infection. We propose that the upregulated immune response to the vaccine acted as a trigger for GCA in this patient with predisposing risk factors and recurrent and repetitive microtrauma in popliteal fossa (the patient is a professional runner). Our case suggests the need for further studies about real world incidence of GCA associated vaccination and COVID-19 infection. Currently, data is limited regarding this relationship. We continue to encourage COVID-19 vaccination, even in elderly patients because the benefits of vaccination far outweigh any theoretical risk of immune dysregulation following administration.

Giant cell arteritis after COVID-19 vaccination/disease: suggestions for further shots?

“…We read with great interest the article of Gabrielli and coll. 1 describing a case of giant cell arteritis (GCA) after COVID-19 mRNA vaccine and COVID-19 asymptomatic infection, since we had the opportunity to visit such a patient at our Institution.…”

Bilateral Axillo-Brachial Artery Stenosis Following Messenger Ribonucleic Acid (mRNA) Vaccination Against Severe Acute Respiratory Coronavirus 2 (COVID-19)

“…In early 2022, several case reports of large vessel and GCA developing after mRNA COVID-19 vaccination were published with multiple authors demonstrating the utility of fluorodeoxyglucose-positron emission tomography in conjunction with computed tomography imaging for diagnosis [16][17][18][19][20][21][22][23][24].…”

Giant cell vasculitis post-COVID-19 mRNA vaccine and COVID-19 asymptomatic infection: Correspondence

“…Dear Editor, we would like to discuss "isolated popliteal artery lesion due to giant cell vasculitis post-COVID-19 mRNA vaccine and COVID-19 asymptomatic infection." 1 Following vaccination with a COVID-19 mRNA vaccine and COVID-19 infection, Gabrielli et al described the first instance of isolated popliteal giant cell arteritis (GCA) that had been documented. 1 In this patient with preexisting risk factors and repetitive and recurring microtrauma in the popliteal fossa (the patient is a professional runner), Gabrielli et al hypothesized that the increased immune response to the immunization served as a trigger for GCA.…”

“…1 In this patient with preexisting risk factors and repetitive and recurring microtrauma in the popliteal fossa (the patient is a professional runner), Gabrielli et al hypothesized that the increased immune response to the immunization served as a trigger for GCA. 1 Further research regarding the prevalence of GCA-associated vaccination and COVID-19 infection in the actual world is recommended by Gabrielli et al 1 Because the advantages of vaccination significantly outweigh any conceivable danger of immunological dysregulation after administration, Gabrielli et al promoted COVID-19 vaccination, especially in older individuals. 1 Prior to getting clinical information from the patient for vaccination, co-morbidity is frequently eliminated.…”

“…1 Further research regarding the prevalence of GCA-associated vaccination and COVID-19 infection in the actual world is recommended by Gabrielli et al 1 Because the advantages of vaccination significantly outweigh any conceivable danger of immunological dysregulation after administration, Gabrielli et al promoted COVID-19 vaccination, especially in older individuals. 1 Prior to getting clinical information from the patient for vaccination, co-morbidity is frequently eliminated. When getting the COVID-19 vaccine, there may be a problem that makes managing co-morbidity challenging.…”