New Onset of Giant Cell Arteritis following ChAdOx1-S (Vaxevria®) Vaccine Administration

Sardo, Luca Lo; Parisi, Simone; Ditto, Maria Chiara; Giovanni, Rosanna De; Maletta, Francesca; Grimaldi, Séréna; Brussino, Luisa; Fusaro, Enrico

doi:10.3390/vaccines11020434

Cited by 4 publications

(7 citation statements)

References 26 publications

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“…One out of eight patients had no headache; however, PET-CT showed widespread FDG activity of the aortic branches, including cranial arteritis [33]. A temporal artery biopsy confirmed the diagnosis in five out of six patients [31,32,114,131,153]. The patient with a negative temporal artery biopsy had positive FDG activity on PET-CT. PET-CT confirmed LVV in 3/4 of patients [33,34,114]; however, one patient with negative PET-CT had a positive temporal artery biopsy [32].…”

Section: Giant-cell Arteritismentioning

confidence: 83%

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

Nune,

Durkowski,

Pillay

et al. 2023

Vaccines

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A comprehensive, up-to-date systematic review (SR) of the new-onset rheumatic immune-mediated inflammatory diseases (R-IMIDs) following COVID-19 vaccinations is lacking. Therefore, we investigated the demographics, management, and prognosis of new R-IMIDs in adults following SARS-CoV-2 vaccinations. A systematic literature search of Medline, Embase, Google Scholar, LitCovid, and Cochrane was conducted. We included any English-language study that reported new-onset R-IMID in adults following the post-COVID-19 vaccination. A total of 271 cases were reported from 39 countries between January 2021 and May 2023. The mean age of patients was 56 (range 18–90), and most were females (170, 62.5%). Most (153, 56.5%) received the Pfizer BioNTech COVID-19 vaccine. Nearly 50% of patients developed R-IMID after the second dose of the vaccine. Vasculitis was the most prevalent clinical presentation (86, 31.7%), followed by connective tissue disease (66, 24.3%). The mean duration between the vaccine’s ‘trigger’ dose and R-IMID was 11 days. Most (220, 81.2%) received corticosteroids; however, 42% (115) received DMARDs such as methotrexate, cyclophosphamide, tocilizumab, anakinra, IV immunoglobulins, plasma exchange, or rituximab. Complete remission was achieved in 75 patients (27.7%), and 137 (50.6%) improved following the treatment. Two patients died due to myositis. This SR highlights that SARS-CoV-2 vaccines may trigger R-IMID; however, further epidemiology studies are required.

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Section: Giant-cell Arteritismentioning

confidence: 83%

“…All patients were diagnosed with giant-cell arteritis (GCA) [31][32][33][34]114,131,153], except one who was less than 50 years old [35]. Two patients had normal CRP.…”

Section: Giant-cell Arteritismentioning

confidence: 99%

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

Nune,

Durkowski,

Pillay

et al. 2023

Vaccines

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“…One possibility is that the vaccine directly might cause pituitary impairment with cumulative effect. Autoimmune/inflammatory syndrome induced by vaccine adjuvants (ASIA syndrome), molecular mimicry, cross-reactivity or a pro-inflammatory state induced by vaccine components and subsequent activation of autoreactive B and T cells are speculated to be involved, as in Guillain-Barrè syndrome or optic neuritis (26)(27)(28).…”

Section: Discussionmentioning

confidence: 99%

AVP deficiency (central diabetes insipidus) following immunization with anti-COVID-19 BNT162b2 Comirnaty vaccine in adolescents: A case report

et al. 2023

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IntroductionThe coronavirus disease 19 (COVID-19) pandemic has prompted the development of new vaccines to reduce the morbidity and mortality associated with this disease. Recognition and report of potential adverse effects of these novel vaccines (especially the urgent and life-threatening ones) is therefore essential.Case presentationA 16-year-old boy presented to the Paediatric Emergency Department with polyuria, polydipsia and weight loss over the last four months. His past medical history was unremarkable. Onset of symptoms was referred to be few days after first dose of anti-COVID-19 BNT162b2 Comirnaty vaccine and then worsened after the second dose. The physical exam was normal, without neurological abnormalities. Auxological parameters were within normal limits. Daily fluid balance monitoring confirmed polyuria and polydipsia. Biochemistry laboratory analysis and urine culture were normal. Serum osmolality was 297 mOsm/Kg H2O (285-305), whereas urine osmolality was 80 mOsm/Kg H2O (100-1100), suggesting diabetes insipidus. Anterior pituitary function was preserved. Since parents refused to give consent to water deprivation test, treatment with Desmopressin was administered and confirmed ex juvantibus diagnosis of AVP deficiency (or central diabetes insipidus). Brain MRI revealed pituitary stalk thickening (4 mm) with contrast enhancement, and loss of posterior pituitary bright spot on T1 weighted imaging. Those signs were consistent with neuroinfundibulohypophysitis. Immunoglobulin levels were normal. Low doses of oral Desmopressin were sufficient to control patient’s symptoms, normalizing serum and urinary osmolality values and daily fluid balance at discharge. Brain MRI after 2 months showed stable thicken pituitary stalk and still undetectable posterior pituitary. Due to persistence of polyuria and polydipsia, therapy with Desmopressin was adjusted by increasing dosage and number of daily administrations. Clinical and neuroradiological follow-up is still ongoing.ConclusionHypophysitis is a rare disorder characterized by lymphocytic, granulomatous, plasmacytic, or xanthomatous infiltration of the pituitary gland and stalk. Common manifestations are headache, hypopituitarism, and diabetes insipidus. To date, only time correlation between SARS-CoV-2 infection and development of hypophysitis and subsequent hypopituitarism has been reported. Further studies will be needed to deepen a possible causal link between anti-COVID-19 vaccine and AVP deficiency.

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“…During the SARS-CoV-2 pandemic, there have been several reports of GCA occurring after COVID-19 vaccination. We conducted a search of PubMed, and identified 13 cases of GCA reported in individuals following COVID-19 vaccination [12][13][14][15][16][17][18][19][20][21][22][23] (Table 2). Of the 14 cases, seven males and seven females, four cases of viral vector vaccine and ten cases of mRNA vaccine were observed.…”

Section: Discussionmentioning

confidence: 99%

“…Some reports have pointed out the potential role of certain viruses, such as cytomegalovirus or varicella zoster, as well as influenza vaccines, as triggers for GCA in predisposed individuals [9][10][11]. Furthermore, GCA that develops after COVID-19 vaccination has been reported [12][13][14][15][16][17][18][19][20][21][22][23], but its characteristics are not clear. Here, we present a case of GCA after COVID-19 vaccination with long-term follow-up and characterize GCA that developed after the COVID-19 vaccine.…”

Section: Introductionmentioning

confidence: 99%

Giant Cell Arteritis after COVID-19 Vaccination with Long-Term Follow-Up: A Case Report and Review of the Literature

Yoshimoto,

Kaneda,

Asada

et al. 2023

Medicina

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Giant cell arteritis (GCA) is a chronic vasculitis that primarily affects the elderly, and can cause visual impairment, requiring prompt diagnosis and treatment. The global impact of the coronavirus disease 2019 (COVID-19) pandemic has been substantial. Although vaccination programs have been a key defense strategy, concerns have arisen regarding post-vaccination immune-mediated disorders and related risks. We present a case of GCA after COVID-19 vaccination with 2 years of follow-up. A 69-year-old woman experienced fever, headaches, and local muscle pain two days after receiving the COVID-19 vaccine. Elevated inflammatory markers were observed, and positron emission tomography (PET) revealed abnormal uptake in the major arteries, including the aorta and subclavian and iliac arteries. Temporal artery biopsy confirmed the diagnosis of GCA. Treatment consisted of pulse therapy with methylprednisolone, followed by prednisolone (PSL) and tocilizumab. Immediately after the initiation of treatment, the fever and headaches disappeared, and the inflammation markers normalized. The PSL dosage was gradually reduced, and one year later, a PET scan showed that the inflammation had resolved. After two years, the PSL dosage was reduced to 3 mg. Fourteen reported cases of GCA after COVID-19 vaccination was reviewed to reveal a diverse clinical picture and treatment response. The time from onset of symptoms to GCA diagnosis varied from two weeks to four months, highlighting the challenge of early detection. The effectiveness of treatment varied, but was generally effective similarly to that of conventional GCA. This report emphasizes the need for clinical vigilance and encourages further data collection in post-vaccination GCA cases.

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New Onset of Giant Cell Arteritis following ChAdOx1-S (Vaxevria®) Vaccine Administration

Cited by 4 publications

References 26 publications

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

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

AVP deficiency (central diabetes insipidus) following immunization with anti-COVID-19 BNT162b2 Comirnaty vaccine in adolescents: A case report

Giant Cell Arteritis after COVID-19 Vaccination with Long-Term Follow-Up: A Case Report and Review of the Literature

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