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Weir C, Sung-In Jang H, Fernando SL. The role of lymphocyte transformation tests (LTT) in suspected severe delayed hypersensitivity reactions following COVID-19 vaccination. Hum Vaccin Immunother 2023; 19:2182527. [PMID: 36912718 PMCID: PMC10054271 DOI: 10.1080/21645515.2023.2182527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Coronavirus (COVID-19) vaccines have proved to be effective in the pandemic response but can cause adverse events such as delayed hypersensitivity reactions (DHRs). Delayed-reading intradermal tests (IDT) to vaccines are limited by false-positive results and may reflect a cell-mediated rather than IgE-mediated immune response. Lymphocyte transformation test (LTT), which has been utilized in the diagnosis of drug allergy, may be helpful in suspected COVID-19 vaccine and/or its excipient-related DHRs. To investigate the use of LTT in two suspected cases of COVID-19 vaccine-induced DHRs, two patients with suspected DHRs to COVID-19 vaccination were tested by delayed-reading IDT and LTT against vaccines and their excipients. A 47-year-old man developed acute mixed-pattern hepatitis after the second dose of ChAdOx1 vaccine. LTT performed at 2 months post-vaccination revealed reactivity to the ChAdOx1 vaccine, polysorbate 80 and mildly to PEG 2050 but not BNT162b2 vaccine. Delayed-reading IDT returned negative to both vaccines and excipients. He tolerated BNT162b2 vaccination with no adverse events. A 36-year-old woman presented with subacute morbilliform eruption and hepatitis after the first dose of BNT162b2 vaccine. LTT performed 3 months later revealed reactivity to the BNT162b2 but not PEG 2050. Repeat LTT following subsequent natural Severe Acute Respiratory Coronavirus-2 (SARS-CoV-2) infection revealed reactivity to ChAdOx1 and NVX-CoV2373 vaccines but not polysorbate 80. Delayed-reading IDT remained negative. She proceeded with NVX-CoV2373 vaccination with no symptom recurrence. LTT may be a useful tool in suspected COVID-19 vaccine-related DHRs. Further evaluation with a larger patient cohort is required.
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Affiliation(s)
- Chris Weir
- Northern Blood Research Laboratory, Kolling Institute of Medical Research, Royal North Shore Hospital and the Sydney Medical School, University of Sydney, Sydney, Australia
- Immunology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, Australia
| | - Helena Sung-In Jang
- Immunology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, Australia
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia
| | - Suran L Fernando
- Immunology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, Australia
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia
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2
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Ruiz-Fernández C, Cuesta R, Martín-López S, Guijarro J, López Gómez de Las Huertas A, Urroz M, Miguel-Berenguel L, González-Muñoz M, Ramírez E. Immune-Mediated Organ-Specific Reactions to COVID-19 Vaccines: A Retrospective Descriptive Study. Pharmaceuticals (Basel) 2023; 16:ph16050720. [PMID: 37242502 DOI: 10.3390/ph16050720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 caused the global COVID-19 pandemic and public health crisis, and it led to the rapid development of COVID-19 vaccines, which can cause rare and typically mild hypersensitivity reactions (HRs). Delayed HRs to COVID-19 vaccines have been reported, and the excipients polyethylene glycol (PEG)2000 and polysorbate 80 (P80) are the suspected culprits. Skin patch tests do not help in diagnosing delayed reactions. We aimed to perform lymphocyte transformation tests (LTT) with PEG2000 and P80 in 23 patients with suspected delayed HRs. Neurological reactions (n = 10) and myopericarditis reactions (n = 6) were the most frequent complications. Seventy-eight percent (18/23) of the study patients were admitted to a hospital ward, and the median time to discharge was 5.5 (IQR, 3-8) days. Some 73.9% of the patients returned to baseline condition after 25 (IQR, 3-80) days. LTT was positive in 8/23 patients (5/10 neurological reactions, 2/4 hepatitis reactions and 1/2 rheumatologic reactions). All myopericarditis cases had a negative LTT. These preliminary results indicate that LTT with PEGs and polysorbates is a useful tool for identifying excipients as causal agents in HRs to COVID-19 vaccines and can play an important role in risk stratification in patients with HRs.
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Affiliation(s)
| | - Ricardo Cuesta
- Immunology Department, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain
| | - Susana Martín-López
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
| | - Javier Guijarro
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
| | - Arturo López Gómez de Las Huertas
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
| | - Mikel Urroz
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
| | | | | | - Elena Ramírez
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
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3
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Delayed Skin Reactions to COVID-19 mRNA-1273 Vaccine: Case Report and Literature Review. Vaccines (Basel) 2022; 10:vaccines10091412. [PMID: 36146490 PMCID: PMC9505581 DOI: 10.3390/vaccines10091412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The COVID-19 mRNA vaccine was granted emergency use authorization (EUA) on December 18, 2020. Some patients experienced a transient, pruritic rash at the injection site, which was referred to as “COVID arm”. It is considered a delayed-type hypersensitivity reaction and occurs mostly in individuals after vaccination with the Moderna vaccine but rarely with other mRNA vaccines. Case Summary: A healthy 33-year-old woman with no history of disease or long-term medication presented with fever and rash on the left upper arm three days after her first vaccination with the mRNA-1273 vaccine (Moderna). Results: After treatment with antihistamines, all lesions gradually resolved over the following 4 to 5 days. Conclusion: We report a case of “COVID arm”: a localized erythematous rash surrounding the injection site that arose three days after the first dose of the Moderna COVID-19 vaccine. Delayed injection site reactions occurred in approximately 0.8% of vaccinated people after the first dose and in approximately 0.2% after the second dose. The lesions persisted for several days and then resolved without treatment. Health care providers were not prepared to address these delayed local reactions to the mRNA-1273 vaccine. Given the scale-up of mass vaccination campaigns worldwide, these skin reactions may likely generate concerns among patients and requests for evaluation. Although these skin reactions have not been consistently recognized, guidance regarding the second dose of the vaccine has varied, and many patients have unnecessarily received antibiotic agents.
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4
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Barei F, Marletta DA, Marti-Marti I, Maronese CA, Genovese G, Marzano AV. Ulcerative injection site reaction after third COVID-19 vaccine dose with mRNA-1273. Dermatol Ther 2022; 35:e15631. [PMID: 35678474 PMCID: PMC9348031 DOI: 10.1111/dth.15631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/05/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Francesca Barei
- Unit of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Dario A Marletta
- Unit of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Ignasi Marti-Marti
- Department of Dermatology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Carlo A Maronese
- Unit of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giovanni Genovese
- Unit of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Angelo V Marzano
- Unit of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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5
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Bouça B, Roldão M, Bogalho P, Cerqueira L, Silva-Nunes J. Central Diabetes Insipidus Following Immunization With BNT162b2 mRNA COVID-19 Vaccine: A Case Report. Front Endocrinol (Lausanne) 2022; 13:889074. [PMID: 35600593 PMCID: PMC9114295 DOI: 10.3389/fendo.2022.889074] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Cases of central diabetes insipidus (CDI) have been reported after COVID-19 infection, with hypophysitis being the most likely cause. COVID-19 vaccines potential adverse effects may mimetize some of these complications. Case Report Woman 37 years old, with rheumatoid arthritis under adalimumab (40 mg twice a month) since December 2018. She was in her usual state of health when she has received the second dose of BNT162b2 mRNA COVID-19 vaccine (June 2021). Seven days later, she started reporting intense thirst and polyuria and consulted her family physician. Blood Analysis creatinine 0.7 mg/dL, glucose 95mg/dL, Na+ 141mEq/L, K+ 3.9 mEq/L, TSH 3.8 mcUI/L (0.38-5.33), FT4 0.9 ng/dL (0.6-1.1), cortisol 215.4 nmol/L (185-624), ACTH 21.9 pg/mL (6- 48), FSH 4.76 UI/L, LH5.62 UI/L, estradiol 323 pmol/L, IGF1 74.8 ng/mL (88-209), PRL 24.7mcg/L (3.3-26.7) osmolality 298.2 mOs/Kg (250- 325); Urine analysis: volume 10200 mL/24h, osmolality 75 mOs/Kg (300-900), density 1.002. On water restriction test: 0' - Serum osmolality 308.8mOsm/Kg vs. urine osmolality 61.0 mOsm/Kg; 60' - urine osmolality 102 mOsm/Kg; urine osmolality 1 h after desmopressine was 511mOsm/kg. MRI revealed no abnormal signs consistent with hypophysitis except for the loss of the posterior pituitary bright spot on T1 weighted imaging. Diagnosis of CDI was assumed, and started therapy with desmopressine. A report of potential adverse effect was addressed to national health authorities. Conclusion In hypophysitis MRI often shows loss of posterior pituitary bright spot on T1 weighted imaging, pituitary enlargement or stalk thickening but those findings were not present in this patient. To the best of our knowledge, CDI has never been reported following administration of a COVID-19 vaccine.
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Affiliation(s)
- Bruno Bouça
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Marisa Roldão
- Department of Nephrology, Centro Hospitalar do Médio Tejo, Torres Novas, Portugal
| | - Paula Bogalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Luís Cerqueira
- Department of Neuroradiology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - José Silva-Nunes
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
- Nova Medical School/Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon, Portugal
- Health and Technology Research Center (H&TRC), Escola Superior de Tecnologia da Saude de Lisboa, Lisbon, Portugal
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6
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Maranini B, Ciancio G, Corazza M, Ruffilli F, Galoppini G, Govoni M. Erythema nodosum after COVID-19 vaccine. Reumatismo 2022; 74. [PMID: 35506318 DOI: 10.4081/reumatismo.2022.1475] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/25/2022] [Indexed: 11/23/2022] Open
Abstract
The current coronavirus disease 2019 (COVID-19) pandemic is a global challenge with strong medical and socioeconomic implications. Hopes have been placed in the development of various vaccines. As the vaccination campaign is in progress, adverse effects need to be monitored closely. Possible side effects range from minor events to more serious manifestations. In this article, we describe two cases of erythema nodosum (EN) after COVID-19 vaccination in two previously healthy female patients of 59 and 51 years, respectively. Most of the usual etiologies of EN were excluded by laboratory testing. EN was successfully treated with corticosteroids. Remarkably, in the first case, a relapse occurred 48 hours after the second dose of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. In this case series, we describe two unusual occurrences of EN after vaccination with an mRNA COVID-19 vaccine and a viral vector vaccine, respectively, and we discuss the available related literature.
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Affiliation(s)
- B Maranini
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara.
| | - G Ciancio
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara.
| | - M Corazza
- Section of Dermatology, Department of Medical Sciences, University of Ferrara.
| | - F Ruffilli
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara.
| | - G Galoppini
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara.
| | - M Govoni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara.
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7
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Maffetone PB, Laursen PB. Rethinking COVID-19 and Beyond: Prevention, Remedies, and Recovery. Front Public Health 2022; 10:748498. [PMID: 35284402 PMCID: PMC8904369 DOI: 10.3389/fpubh.2022.748498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
In a relatively short timeframe, millions of deaths and illnesses associated with COVID-19 have been reported, accompanied by substantial economic losses, and overall, negatively impacting society. This experience should serve as a wakeup call to those in public health and healthcare, along with politicians and citizens: COVID-19 is considered a predictable and preventable disaster. While various reactive responses to address the pandemic were implemented, some with adverse effects, proactive measures in the years before COVID-19 were neglected. Predominately this involved the development of a preventable overfat pandemic, which played a key role in both rising rates of chronic disease, the comorbidities that increase the risk for COVID-19, along with associated inflammation and malnutrition. This increased the risk of infection in billions of people worldwide, which, in essence, primed society for high rates of COVID-19 infection. Excess body fat evolves primarily from poor nutrition, particularly the overconsumption of sugar and other refined carbohydrates, which replace the vital nutrients needed for optimal immune function. Sugar and refined carbohydrates must be considered the new tobacco, as these foods are also devoid of nutrients, and underly inflammatory chronic diseases. A balanced diet of nutrient-dense wholefood must be emphasized to combat infectious and inflammatory diseases. Implementing proactive preventive lifestyle changes must begin now, starting with simple, safe, and inexpensive dietary modifications that can quickly lead to a healthier population.
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8
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Huang Z, Su Y, Zhang T, Xia N. A review of the safety and efficacy of current COVID-19 vaccines. Front Med 2022; 16:39-55. [PMID: 35122210 PMCID: PMC8815389 DOI: 10.1007/s11684-021-0893-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/24/2021] [Indexed: 01/06/2023]
Abstract
Vaccination is the most effective and feasible way to contain the Coronavirus disease 2019 (COVID-19) pandemic. The rapid development of effective COVID-19 vaccines is an extraordinary achievement. This study reviewed the efficacy/effectiveness, immunogenicity, and safety profile of the 12 most progressed COVID-19 vaccines and discussed the challenges and prospects of the vaccine-based approaches in a global crisis. Overall, most of the current vaccines have shown safety and efficacy/effectiveness during actual clinical trials or in the real-world studies, indicating a development of pandemic control. However, many challenges are faced by pandemic control in terms of maximizing the effect of vaccines, such as rapid vaccine coverage, strategies to address variants with immune escape capability, and surveillance of vaccine safety in the medium- and long-terms.
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Affiliation(s)
- Zehong Huang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, 361102, China
| | - Yingying Su
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, 361102, China
| | - Tianying Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, 361102, China
| | - Ningshao Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, 361102, China.
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9
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Abstract
Background The increasing number of reports on cutaneous reactions following COVID-19 vaccination has led to growing concerns among certain groups. Objective We reviewed the published reports of cutaneous lesions after COVID-19 vaccination. Methods We conducted a literature search for original and review articles published between January 1, 2020, and September 27, 2021. Results Eleven cutaneous reactions associated with COVID-19 vaccines were determined; the most prevalent reactions were local injection site reactions, delayed local reactions, urticaria, angioedema, and morbilliform eruptions. There were more reports on skin reactions following the administration of messenger RNA-based vaccines than on those following the administration of adenoviral vector or inactivated whole-virus vaccines, in part, due to their higher administration rate. Most reported skin reactions occurred after the first vaccine dose. Limitations A reporting bias could not be excluded, and skin biopsy results were not available for most included individuals. Moreover, given that the included trials focused on vaccine efficacy, there was a lack of details concerning cutaneous reactions and participant information. Conclusion Not all cutaneous reactions observed after COVID-19 vaccination are hypersensitivity reactions. Different cutaneous reactions may reflect underlying immune responses to the vaccines. A large majority of COVID-19 vaccination reactions were mild and self-limiting, and people should be encouraged to complete their vaccination regimen.
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10
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Chapin-Bardales J, Myers T, Gee J, Shay DK, Marquez P, Baggs J, Zhang B, Licata C, Shimabukuro TT. Reactogenicity within 2 weeks after mRNA COVID-19 vaccines: Findings from the CDC v-safe surveillance system. Vaccine 2021; 39:7066-7073. [PMID: 34763946 PMCID: PMC8519847 DOI: 10.1016/j.vaccine.2021.10.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Post-authorization monitoring of mRNA-based COVID-19 vaccines is needed to better characterize their reactogenicity. We assessed reactions reported during the 2 weeks after receipt of BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) vaccines. METHODS We monitored persons who enrolled in v-safe after vaccination health checkerSM, a U.S. smartphone-based vaccine monitoring system, after receiving BNT162b2 or mRNA-1273. V-safe participants received text message prompts to complete web-based surveys. We analyzed responses from persons who received BNT162b2 or mRNA-1273 from December 14, 2020 through March 14, 2021 and completed at least one survey by March 28, 2021. We measured the proportion of participants reporting local and systemic reactions solicited in surveys completed days 0 through 7 post-vaccination. For day 14 surveys, participants described new or worsening symptoms in a free-text response. We assessed the proportion of participants reporting new or worsening local and systemic reactions. RESULTS One-third of participants were aged <45 years, two-thirds were female, and approximately half received BNT162b2 vaccine. A total of 4,717,908 participants reported during the 7 days after dose 1 and 2,906,377 reported during the 7 days after dose 2. Most reported at least one injection-site reaction (68.5% after dose 1; 72.9% after dose 2) or at least one systemic reaction (50.6% after dose 1; 69.5% after dose 2). Reactogenicity was greater after dose 2 and among mRNA-1273 recipients, persons aged <45 years, and females. New or worsening local and systemic reactions were uncommon during week 2 after either dose; the most frequent were local reactions for dose 1 mRNA-1273 recipients (2.6%). These reactions were reported more often among females after dose 1 mRNA-1273 (3.6%). CONCLUSIONS During post-authorization monitoring among >4 million vaccinees, local and systemic reactions were commonly reported following mRNA-based vaccines. Reactions were most common during the first week following dose 2 and among persons aged <45 years, females, and mRNA-1273 recipients.
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Affiliation(s)
- Johanna Chapin-Bardales
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, USA
| | - Tanya Myers
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, USA
| | - Julianne Gee
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, USA.
| | - David K Shay
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, USA
| | - Paige Marquez
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, USA
| | - James Baggs
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, USA
| | - Bicheng Zhang
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, USA
| | - Charles Licata
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, USA
| | - Tom T Shimabukuro
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, USA
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11
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Terashima T. Delayed large pruritic eruption to the BNT162b2 mRNA vaccine. IDCases 2021; 26:e01297. [PMID: 34603964 PMCID: PMC8463103 DOI: 10.1016/j.idcr.2021.e01297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 11/08/2022] Open
Affiliation(s)
- Takeshi Terashima
- Department of Respiratory Medicine, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba 272-0824, Japan
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12
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Murvelashvili N, Tessnow A. A Case of Hypophysitis Following Immunization With the mRNA-1273 SARS-CoV-2 Vaccine. J Investig Med High Impact Case Rep 2021; 9:23247096211043386. [PMID: 34553641 PMCID: PMC8474296 DOI: 10.1177/23247096211043386] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The emergence of a novel coronavirus and global pandemic raised the need for the rapid development of new vaccines to reduce the morbidity and mortality associated with Covid-19. Common side effects of these vaccines such as myalgia, arthralgia, nausea, fatigue, and injection site reaction are usually self-resolving. Recognition of other potential adverse effects of these novel vaccines is important due to their rapid and widespread distribution. We report a case of a 51-year-old man admitted to Parkland Memorial Hospital with headache, nausea, vomiting, malaise, and diffuse arthralgias 3 days after he received his second mRNA-1273 SARS-CoV-2 vaccination. He was found to have hyponatremia and a low serum cortisol level. Further workup revealed hypopituitarism with central hypothyroidism, hypogonadism, and a subnormal response to cosyntropin. Magnetic resonance imaging revealed a diffusely enlarged pituitary gland consistent with acute hypophysitis. The patient responded well to glucocorticoid and thyroid hormone supplementation and was discharged after 2 days in the hospital. This is the first reported case of hypopituitarism potentially associated with Covid-19 immunization.
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Affiliation(s)
| | - Alex Tessnow
- The University of Texas Southwestern Medical Center, Dallas, USA
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13
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Fathy RA, McMahon DE, Lee C, Chamberlin GC, Rosenbach M, Lipoff JB, Tyagi A, Desai SR, French LE, Lim HW, Thiers BH, Hruza GJ, Fassett M, Fox LP, Greenberg HL, Blumenthal K, Freeman EE. Varicella-zoster and herpes simplex virus reactivation post-COVID-19 vaccination: a review of 40 cases in an International Dermatology Registry. J Eur Acad Dermatol Venereol 2021; 36:e6-e9. [PMID: 34487581 PMCID: PMC8656951 DOI: 10.1111/jdv.17646] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/02/2021] [Indexed: 01/23/2023]
Affiliation(s)
- R A Fathy
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - D E McMahon
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - C Lee
- Department of Dermatology, Las Vegas School of Medicine, University of Nevada, Las Vegas, NV, USA
| | - G C Chamberlin
- Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - M Rosenbach
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - J B Lipoff
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - A Tyagi
- Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - S R Desai
- The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Innovative Dermatology, Plano, TX, USA
| | - L E French
- Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany.,Dr. Philip Frost, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - H W Lim
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - B H Thiers
- Department of Dermatology and Dermatologic Surgery, Medical University of SC, Charleston, SC, USA
| | - G J Hruza
- Department of Dermatology, St. Louis University, St. Louis, MO, USA
| | - M Fassett
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - L P Fox
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | | | - K Blumenthal
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - E E Freeman
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.,Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
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14
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Sato T. Five Japanese cases of delayed large local reactions to coronavirus disease 2019 vaccines. J Dermatol 2021; 48:e558-e559. [PMID: 34459023 PMCID: PMC8652438 DOI: 10.1111/1346-8138.16123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
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15
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Samarakoon U, Alvarez-Arango S, Blumenthal KG. Delayed Large Local Reactions to mRNA Covid-19 Vaccines in Blacks, Indigenous Persons, and People of Color. N Engl J Med 2021; 385:662-664. [PMID: 34126004 PMCID: PMC8219056 DOI: 10.1056/nejmc2108620] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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Kempf W, Kettelhack N, Kind F, Courvoisier S, Galambos J, Pfaltz K. 'COVID arm' - histological features of a delayed-type hypersensitivity reaction to Moderna mRNA-1273 SARS-CoV2 vaccine. J Eur Acad Dermatol Venereol 2021; 35:e730-e732. [PMID: 34242422 PMCID: PMC8447314 DOI: 10.1111/jdv.17506] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- W Kempf
- Kempf und Pfaltz Histologische Diagnostik, Zurich, Switzerland
| | - N Kettelhack
- Dermatologisches Zentrum Zürich, Zurich, Switzerland
| | - F Kind
- Dermatology Practice, Eschen, Liechtenstein
| | | | - J Galambos
- Kempf und Pfaltz Histologische Diagnostik, Zurich, Switzerland
| | - K Pfaltz
- Kempf und Pfaltz Histologische Diagnostik, Zurich, Switzerland
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17
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Kim JE, Lee H, Paik SS, Moon JY, Yoon HJ, Kim SH. Delayed cutaneous reaction to ChAdOx1 nCoV-19 vaccine: Is it an 'AstraZeneca arm'? J Eur Acad Dermatol Venereol 2021; 35:e711-e714. [PMID: 34166540 PMCID: PMC8447195 DOI: 10.1111/jdv.17476] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/28/2021] [Accepted: 06/23/2021] [Indexed: 12/01/2022]
Affiliation(s)
- J E Kim
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - H Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - S S Paik
- Department of Pathology, Hanyang University College of Medicine, Seoul, Korea
| | - J-Y Moon
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - H J Yoon
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - S-H Kim
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
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