Systemic lupus erythematous after Pfizer COVID-19 vaccine: a case report

Abstract

The Pfizer-BioNTech COVID-19 vaccine has been authorized by the U.S. Food and Drug Administration as it demonstrated 95% effectiveness against the SARS-CoV-2 virus. Although the initial vaccine trials showed a favorable side effect profile, there have been concerns regarding activation of aberrant immune responses, triggering autoimmunity. This is a case report of a 68-year-old woman without history of autoimmune conditions, who presented to our emergency department 7 days after receiving the Pfizer-BioNTech COVID-19 vaccine. Her initial symptoms were suggestive of polymyalgia rheumatica, and she had nearly complete response to steroids. Interestingly, she later met criteria for classified systemic lupus erythematous given the development of inflammatory arthritis, positive ANA, and positive dsDNA. The temporal relationship of her symptoms that started 2 days after vaccine administration could suggest a possible association between the Pfizer-BioNTech COVID-19 and the development of systemic lupus erythematous.

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).…”

“…Lemoine et al reported an SLE patient presenting with inflammatory arthritis, positive ANA and elevated dsDNA in a 68-year-old woman without previous history of autoimmune diseases, around seven days following receiving the first dose of the Pfizer-BioNTech COVID-19 vaccine. This patient recovered significantly after the use of steroids (22).…”

Systematic lupus erythematous patients following COVID-19 vaccination: Its flares up and precautions

“…Kanduc et al examined peptide sharing between the SARS-CoV-2 spike protein and human proteins and discovered significant sharing at the heptapeptide level [ 19 ] suggesting that antibodies produced in response to the vaccine may cross-react with the host and cause autoimmune diseases in susceptible individuals [ 20 ]. Following mRNA vaccination, various pro-inflammatory pathways are triggered as a result of the mRNA itself, liposomes or lipid nanoparticles used to encapsulate the mRNA, and receptor binding essential for spike protein translation [ 21 ].…”

Exacerbation of Chronic Cutaneous Lupus Erythematosus Triggered by Vaccine Against COVID-19

“…Little is known about COVID-19 vaccination in patients with autoimmune skin diseases; however, cases of onset and exacerbation of cutaneous and systemic lupus erythematosus have been reported following the use of immunizers. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 This report describes a chronic cutaneous lupus erythematosus (CCLE) exacerbation thirty days after the second dose of ChAdOx1 nCoV-19 vaccine (Oxford/AstraZeneca).…”

“… 3 The onset or exacerbation of lupus after vaccination is rare, with few cases in the literature. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 The international VACOLUP study indicated that COVID-19 vaccine was well tolerated in patients with systemic lupus erythematosus. Among the 696 participants assessed, only 3% reported a medically confirmed SLE flare after the immunization.…”