New‐onset autoimmune phenomena post‐COVID‐19 vaccination

Abstract

Coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to an unprecedented setback for global economy and health. Vaccination is one of the most effective interventions to substantially reduce severe disease and death due to SARS-CoV-2 infection.Vaccination programmes are being rolled out globally, but most of these vaccines have been approved without extensive studies on their side-effects and efficacy.Recently, new-onset autoimmune phenomena after COVID-19 vaccination have been reported increasingly (e.g. immune thrombotic thrombocytopenia, autoimmune liver diseases, Guillain-Barré syndrome, IgA nephropathy, rheumatoid arthritis and systemic lupus erythematosus). Molecular mimicry, the production of particular autoantibodies and the role of certain vaccine adjuvants seem to be substantial contributors to autoimmune phenomena. However, whether the association between COVID-19 vaccine and autoimmune manifestations is coincidental or causal remains to be elucidated. Here, we summarize the emerging evidence about autoimmune manifestations occurring in response to certain COVID-19 vaccines.Although information pertaining to the risk of autoimmune disease as a consequence of vaccination is controversial, we merely propose our current understanding of autoimmune manifestations associated with COVID-19 vaccine. In fact, we do not aim to disavow the overwhelming benefits of mass COVID-19 vaccination in preventing COVID-19 morbidity and mortality. These reports could help guide clinical assessment and management of autoimmune manifestations after COVID-19 vaccination.

Autoimmune mucocutaneous blistering diseases after SARS-Cov-2 vaccination: A Case report of Pemphigus Vulgaris and a literature review

“…In this case-series, the sub-epithelial diseases represented the majority of the cases (80.0%), especially the BP type, followed by the intraepithelial disease (20.0%). The median ages of AIBDs onset in these patients did not differ from those reported for the spontaneous forms [6] . Interestingly, males were more affected than females (F:M=1:1.7) especially in the sub-epithelial group (F:M=1:2.1).…”

“…Interestingly, males were more affected than females (F:M=1:1.7) especially in the sub-epithelial group (F:M=1:2.1). Conversely, no gender difference has been reported in respect of any of pemphigoid diseases occurring spontaneously [6] . Notably, almost the 62.5% of the AIBDs cases developed after Pfizer vaccine administration.…”

Systemic lupus erythematosus with acute pancreatitis and vasculitic rash following COVID-19 vaccine: a case report and literature review

“…The potential pathophysiology of which the mRNA Pfizer/BioNTech vaccine can induce autoimmune disease like SLE could be related to the vaccine adjuvants that trigger the NLR pyrin domain containing 3 (NLRP3) inflammasome which plays a major role in innate and adaptive immune system [5].…”

“…On December 2020, the US Food and Drug Administration (FDA) approved using the Pfizer-BioNTech mRNA COVID-19 vaccine to help overcome this pandemic [3]. This vaccine's safety profile was reassuring, but emerging concerns about cross-reactivity with human tissue may have contributed to the development of vaccine-associated immune-mediated diseases (IMDs) such as vaccine-induced immune thrombotic thrombocytopenia, autoimmune liver disease, IgA nephropathy, rheumatoid arthritis, and systemic lupus erythematosus (SLE) [4,5]. SLE is an autoimmune disease that appears to be associated with some vaccine administration; a recent investigational cross-sectional study (the international VACOLUP study) that examined vaccine tolerability in SLE patients showed reassuring signals regarding vaccine tolerability with a minimal risk of a disease flare-up [6].…”

Two flares of Still’s disease after two doses of the ChAdOx1 vaccine

“…Vaccine-induced autoimmunity is a known but poorly understood concept. With respect to the COVID-19 vaccine, various reports of vaccine induced autoimmunity have been published [ 1 , 2 ]. Arthritis, pericarditis, uveitis, immune thrombocytopenia, autoimmune liver diseases, and other autoimmune rheumatic diseases like lupus and rheumatoid arthritis have been reported.…”