Systemic lupus erythematosus and antiphospholipid syndrome after COVID-19 vaccination. A case report

Abstract

Introduction COVID-19 vaccines have some adverse effects, mostly mild. However, by presenting an immunological challenge to the individual, they could infrequently trigger immune-mediated diseases. Case report We report the case of a 42-year-old woman, with no previous medical history, who received the first dose of vaccine against COVID-19 and developed inflammatory arthralgias, associated with sudden onset dyspnea and hypoxemia. Pulmonary thromboembolism was documented and the diagnosis of systemic lupus erythematosus (SLE) and secondary antiphospholipid syndrome (APS) was suspected. Autoantibodies were measured confirming this suspicion. After a few days, she presented a massive pericardial effusion with cardiac tamponade that required surgical management. She received treatment with hydroxychloroquine, corticosteroids and anticoagulation with improvement of all symptoms. Discussion There is controversy regarding the potential of COVID-19 vaccines to induce autoimmunity. Studies addressing the safety of using these vaccines have reported the occurrence of mild local and systemic reactions, most frequently in young adults. So far there are few reports of patients who have developed autoimmune or autoinflammatory diseases after getting vaccinated with any of the COVID-19 vaccines. To the best of our knowledge, to date this is one of the first cases of new-onset SLE and secondary APS after COVID-19 vaccination.

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

“…The adverse events were negligible and there were no severe adverse events in both groups of SLE cases and healthy individuals after SARS-CoV-2 inactivated vaccine (31). This is in sharp contrast to other mentioned reports with increased side effects and flares with use of mRNA COVID-19 vaccines such as Pfizer/BioNTech (BNT162b2) (12)(13)(14)17,18,(20)(21)(22)(23)25,26), AZD1222 vaccine (15,16) and Moderna (19,24).…”

“…This patient presented as the first case of SLE with antiphospholipid syndrome along with inflammatory arthritis, high erythrocyte sedimentation rate and C-reactive protein levels, after receiving the first dose of Pfizer/BioNTech vaccine. Treatment with anticoagulation, hydroxychloroquine, azathioprine, and corticosteroids, resulted in the improvement of all her manifestations (18).…”

COVID-19 Vaccines and Autoimmune Hematologic Disorders

“…These considerations suggest that aPLs may represent a thrombotic risk factor following COVID-19 vaccination [112]. These data could support mRNA vaccine as a trigger for APS and catastrophic antiphospholipid syndrome (CAPS), although several case reports of both conditions after SARS-CoV-2 vaccination have been published [113][114][115][116], other serie do not confirm this hypothesis [117]. In this series of high risk APS patients (triple-positive aPL confirmed 12 weeks apart), out of 161 patients interviewed, 18 (11%) had COVID-19.…”

A case series of dermatomyositis following SARS-CoV-2 vaccination

“…Indeed, it has recently been suggested that patients with SLE may have increased frequencies of gain of function mutations in TLR7 which are sufficient to promote inflammatory manifestations associated with SLE such as chronic B cell activation ( 29 ). This may explain why several groups have reported new diagnoses of SLE or severe SLE flares after COVID-19 vaccinations as we have described for DM ( 30 – 33 ). As TLR7 plays a prominent role in the pathogenesis of DM ( 34 ), we suspect that TLR7 agonists such as those present in RNA/DNA vaccines utilized for COVID-19 may be sufficient to promote inflammatory signals associated with DM.…”