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Ueda Y, Sakai T, Yamada K, Arita K, Ishige Y, Hoshi D, Yanagisawa H, Iwao-Kawanami H, Kawanami T, Mizuta S, Fukushima T, Yamada S, Yachie A, Masaki Y. Fatal hemophagocytic lymphohistiocytosis with intravascular large B-cell lymphoma following coronavirus disease 2019 vaccination in a patient with systemic lupus erythematosus: an intertwined case. Immunol Med 2024:1-8. [PMID: 38619098 DOI: 10.1080/25785826.2024.2338594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/31/2024] [Indexed: 04/16/2024] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) has been recognized as a rare adverse event following the coronavirus disease 2019 (COVID-19) vaccination. We report a case of neuropsychiatric symptoms and refractory HLH in a woman with systemic lupus erythematosus (SLE) after receiving her COVID-19 vaccine treated with belimumab, later found to have intravascular large B-cell lymphoma (IVLBCL) at autopsy. A 61-year-old woman with SLE was referred to our hospital because of impaired consciousness and fever. One month prior to consulting, she received her second COVID-19 vaccine dose. Afterward, her consciousness level decreased, and she developed a high fever. She tested negative for SARS-CoV-2. Neuropsychiatric SLE was suspected; therefore, glucocorticoid pulse therapy was initiated on day 1 and 8. She had thrombocytopenia, increased serum ferritin levels and hemophagocytosis. The patient was diagnosed with HLH and treated with etoposide, dexamethasone and cyclosporine. Despite treatment, the patient died on day 75; autopsy report findings suggested IVLBCL as the underlying cause of HLH. Differentiating comorbid conditions remains difficult; however, in the case of an atypical clinical presentation, other causes should be considered. Therefore, we speculate that the COVID-19 vaccination and her autoimmune condition may have expedited IVLBCL development.
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Affiliation(s)
- Yusuke Ueda
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
| | - Tomoyuki Sakai
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
| | - Kazunori Yamada
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
- Department of Medical Education, Kanazawa Medical University, Uchinada, Japan
| | - Kotaro Arita
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
| | - Yoko Ishige
- Department of Respiratory Medicine, Kanazawa Medical University, Uchinada, Japan
| | - Daisuke Hoshi
- Department of Oncologic Pathology, Kanazawa Medical University, Uchinada, Japan
| | - Hiroto Yanagisawa
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
| | - Haruka Iwao-Kawanami
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
| | - Takafumi Kawanami
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
| | - Shuichi Mizuta
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
| | - Toshihiro Fukushima
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
| | - Sohsuke Yamada
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Uchinada, Japan
| | - Akihiro Yachie
- Division of Medical Safety, Kanazawa University Hospital, Kanazawa, Japan
| | - Yasufumi Masaki
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
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Kim JH, Chung JY, Bong JB. Probable secondary hemophagocytic lymphohistiocytosis manifesting as central nervous system lesions after COVID-19 vaccination: a case report. Front Neurol 2024; 15:1363072. [PMID: 38529033 PMCID: PMC10962393 DOI: 10.3389/fneur.2024.1363072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/26/2024] [Indexed: 03/27/2024] Open
Abstract
Background Hemophagocytic lymphohistiocytosis (HLH) is a rare systemic inflammatory disease commonly characterized by histiocyte infiltration in multiple organs, such as the liver, spleen, lymph nodes, bone marrow, and central nervous system. The clinical features of HLH include fever, splenomegaly, cytopenia, hypertriglyceridemia, hypofibrinogenemia, and elevated blood ferritin levels. HLH is categorized as either primary or secondary. Coronavirus disease 2019 (COVID-19) vaccines may occasionally trigger secondary HLH, which is related to hyperinflammatory syndrome. Case presentation A 58-year-old woman, previously diagnosed with Graves' disease, presented with cognitive decline 2 weeks after receiving the first dose of the ChAdOx1 nCoV-19 vaccine. Brain MRI revealed a hyperintense lesion on T2-weighted and fluid-attenuated inversion recovery images in the bilateral subcortical white matter and right periventricular area. Vaccination-associated acute disseminated encephalomyelitis was suspected and methylprednisolone and intravenous immunoglobulin (IVIg) were administered. From the 5th day of IVIg administration, the patient developed fever and pancytopenia. In the findings of bone marrow biopsy, hemophagocytosis was not observed; however, six of the eight diagnostic criteria for HLH-2004 were met, raising the possibility of HLH. Although there was no definitive method to confirm causality, considering the temporal sequence, suspicion arose regarding vaccine-induced HLH. Splenectomy was considered for therapeutic and diagnostic purposes; however, the patient died on the 28th day of hospitalization owing to multiple organ failure. Conclusion To date, 23 cases of COVID-19 vaccine-related HLH have been reported. Additionally, HLH in COVID-19 patients has been reported in various case reports. To the best of our knowledge, this is the first reported case of central nervous system involvement in HLH related to any type of COVID-19 vaccine. This case suggests that even when there are no systemic symptoms after COVID-19 vaccination, HLH should be considered as a differential diagnosis if brain lesions are suggestive of CNS demyelinating disease.
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Affiliation(s)
| | | | - Jeong Bin Bong
- Department of Neurology, Chosun University College of Medicine, Gwangju, Republic of Korea
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Premec H, Živko M, Mijić M, Jelić-Puškarić B, Lalovac M, Filipec Kanižaj T, Sobočan N. Acute Liver Failure Caused by Secondary Hemophagocytic Lymphohistiocytosis After COVID-19 Vaccination - Case Report and Literature Review. Int Med Case Rep J 2023; 16:449-455. [PMID: 37577009 PMCID: PMC10416787 DOI: 10.2147/imcrj.s417347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/22/2023] [Indexed: 08/15/2023] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a congenital or acquired hyperinflammatory syndrome, in some cases accompanied by acute liver failure. We present a case report of acute liver failure associated with HLH after COVID-19 vaccination and bring a literature review of the connection between HLH and COVID-19 vaccination. HLH has significant mortality rate, and liver transplantation is not a therapeutic option. Therefore, early recognition and timely conservative treatment are corner stones in reducing HLH-related morbidity and mortality.
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Affiliation(s)
- Hrvoje Premec
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia
| | - Matea Živko
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Maja Mijić
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia
| | - Biljana Jelić-Puškarić
- Department of Pathology and Cytology, University Hospital Merkur, Zagreb, Croatia
- School of Medicine, Catholic University of Croatia, Zagreb, Croatia
| | - Miloš Lalovac
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia
- University of Dubrovnik, Dubrovnik, Croatia
| | - Tajana Filipec Kanižaj
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Nikola Sobočan
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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Zhang HQ, Cao BZ, Cao QT, Hun M, Cao L, Zhao MY. An analysis of reported cases of hemophagocytic lymphohistiocytosis (HLH) after COVID-19 vaccination. Hum Vaccin Immunother 2023; 19:2263229. [PMID: 37811764 PMCID: PMC10563610 DOI: 10.1080/21645515.2023.2263229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/22/2023] [Indexed: 10/10/2023] Open
Abstract
Although COVID-19 vaccines are an effective public health tool to combat the global pandemic, serious adverse events, such as hemophagocytic lymphohistiocytosis (HLH), caused by them are a concern. In this systematic review, cases of HLH reported after COVID-19 vaccination have been examined to understand the relationship between the two and propose effective therapeutic strategies. Furthermore, ruxolitinib's potential as a cytokine inhibitor and its affinity for CD25 were initially assessed through molecular docking, aiming to aid targeted HLH therapy. PubMed and Web of Science databases were searched for published individual case reports on the occurrence of HLH after the administration of any COVID-19 vaccine. A total of 17 articles (25 patients) were included in this qualitative analysis. Furthermore, molecular docking was employed to investigate the therapeutic potential of ruxolitinib for HLH after COVID-19 vaccination. The mean age of patients who developed HLH after COVID-19 vaccination was 48.1 years. Most HLH episodes occurred after the BNT162b2 mRNA COVID-19 vaccination (14/25 cases) and to an extent after the ChAdOx1 nCov-19 vaccination (5/25 cases). Almost all affected patients received steroid and antibiotic therapy. Three patients died despite treatment because of esophagus rupture, neutropenic fever, bacteroides bacteremia, refractory shock, and encephalopathy and shock. Visual docking results of IL-2 Rα and ruxolitinib using the Discovery Studio 2019 Client software yielded a model score of 119.879. The findings highlight the importance of considering and identifying the adverse effects of vaccination and the possibility of using ruxolitinib for treating HLH after COVID-19 vaccination.
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Affiliation(s)
- Han-Qi Zhang
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Bu-Zi Cao
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- Medical School, Hunan Normal University, Changsha, China
| | - Qing-Tai Cao
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- Transplantation Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Marady Hun
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lin Cao
- Academician Workstation, Changsha Medical University, Changsha, China
- Hunan Provincial Key Laboratory of the Research and Development of Novel Pharmaceutical Preparations, Changsha Medical University, Changsha, China
| | - Ming-Yi Zhao
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
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Zeylabi F, Nameh Goshay Fard N, Parsi A, Pezeshki SMS. Bone marrow alterations in COVID-19 infection: The root of hematological problems. Curr Res Transl Med 2023; 71:103407. [PMID: 37544028 DOI: 10.1016/j.retram.2023.103407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/04/2023] [Accepted: 07/24/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION The 2019 coronavirus disease (COVID-19) is a respiratory infection caused by the SARS-CoV-2 virus with a significant impact on the hematopoietic system and homeostasis. The effect of the virus on blood cells indicates the involvement of the bone marrow (BM) as the place of production and maturation of these cells by the virus and it reminds the necessity of investigating the effect of the virus on the bone marrow. METHOD To investigate the effects of COVID-19 infection in BM, we reviewed literature from the Google Scholar search engine and PubMed database up to 2022 using the terms "COVID-19; SARS-CoV-2; Bone marrow; Thrombocytopenia; Hemophagocytosis; Pancytopenia and Thrombocytopenia. RESULTS Infection with the SARS-CoV-2 virus is accompanied by alterations such as single-line cytopenia, pancytopenia, hemophagocytosis, and BM necrosis. The presence of factors such as cytokine release syndrome, the direct effect of the virus on cells through different receptors, and the side effects of current treatments such as corticosteroids are some of the important mechanisms in the occurrence of these alterations. CONCLUSION To our knowledge, this review is the first study to comprehensively investigate BM alterations caused by SAR-CoV-2 virus infection. The available findings show that the significant impact of this viral infection on blood cells and the clinical consequences resulting from them are deeper than previously thought and it may be rooted in the changes that the virus causes in the BM of patients.
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Affiliation(s)
- Fatemeh Zeylabi
- Cellular and Molecular Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Najmeh Nameh Goshay Fard
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Abazar Parsi
- Alimentary Tract Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Shimada Y, Nagaba Y, Okawa H, Ehara K, Okada S, Yokomori H. A case of hemophagocytic lymphohistiocytosis after BNT162b2 COVID-19 (Comirnaty®) vaccination. Medicine (Baltimore) 2022; 101:e31304. [PMID: 36316859 PMCID: PMC9622336 DOI: 10.1097/md.0000000000031304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
RATIONALE Coronavirus disease (COVID-19), an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 virus, was reported in Wuhan of China in December 2019. The world is still in a state of pandemic owing to COVID-19. COVID-19 vaccines help our bodies develop immunity against the virus that causes COVID-19 without having to get the illness. Herein, we describe a rare case of a critical disorder, hemophagocytic lymphohistiocytosis (HLH), in a patient with nephritic sclerosis associated with hypertension, following mRNA COVID-19 vaccination. HLH is a life-threatening hyperinflammatory syndrome caused by aberrantly activated macrophages and cytotoxic T cells that may rapidly progress to terminal multiple organ failure. PATIENT CONCERNS An 85-year-old Japanese woman with chronic renal failure and hypertension was included in this study. Routine laboratory investigations provided the following results: white blood cell (WBC) count, 4.6 × 109/L; hemoglobin (Hb), 8.1 g/dL; platelet count, 27 × 109/L; blood urea nitrogen 48.9 mg/dL, and serum creatinine 3.95 mg/dL. The patient developed malaise, vomiting, and persistent high fever (up to 39.7°C) on the 12th day after receiving the second dose of the vaccine. Initial evaluation revealed neutropenia. The total WBC count was 0.40 × 109/L (Neutrophils 0, Lymphocytes 240/μ, blast 0%); Hb 9.0 g/dL, platelet count 27 × 109/L; and, C Reactive Protein 9.64 mg/dL. DIAGNOSIS Further tests showed hyperferritinemia (serum ferritin 2284.4 μg/L). Bone marrow examination revealed haemophagocytosis. A provisional diagnosis of HLH associated with the Comirnaty® vaccination was made based on the HLH-2004 diagnostic criteria. INTERVENTIONS The patient was treated with granulocyte colony-stimulating factor and 500 mg methylprednisolone. OUTCOMES A significant improvement was observed in the patient's condition; the abnormal laboratory results resolved gradually, and the patient was discharged. LESSONS This case serves to create awareness among clinicians that HLH is a rare complication of COVID-19 vaccination and should be considered, especially in patients with a history of chronic renal failure and hypertension.
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Affiliation(s)
- Yoshitaka Shimada
- Department of Internal Medicine, Kitasato University Medical Center, Saitama, Japan
| | - Yasushi Nagaba
- Department of Internal Medicine, Kitasato University Medical Center, Saitama, Japan
| | - Hiroyuki Okawa
- Department of Internal Medicine, Kitasato University Medical Center, Saitama, Japan
| | - Kaori Ehara
- Department of Internal Medicine, Kitasato University Medical Center, Saitama, Japan
| | - Shinya Okada
- Division of Pathology, Kitasato University Medical Center, Saitama, Japan
| | - Hiroaki Yokomori
- Department of Internal Medicine, Kitasato University Medical Center, Saitama, Japan
- * Correspondence: Hiroaki Yokomori, Department of Internal Medicine, Kitasato University Medical Center, Saitama 365-8501, Japan (e-mail: )
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Idiopathic Multicentric Castleman Disease Occurring Shortly after mRNA SARS-CoV-2 Vaccine. Vaccines (Basel) 2022; 10:vaccines10101725. [PMID: 36298590 PMCID: PMC9609308 DOI: 10.3390/vaccines10101725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 11/05/2022] Open
Abstract
Idiopathic Multicentric Castleman Disease (iMCD) is a potentially life-threatening systemic disease whose complex symptomatology is due to cytokine dysregulation. We, herein, present a case of severe iMCD occurring in a previously healthy young man shortly after mRNA SARS-CoV-2 vaccination, responding to interleukin-6 blockade with siltuximab. Six months after the completion of siltuximab, the patient remained without any signs of iMCD or inflammation, indicating a temporal trigger of the disease. This case not only adds to the potential pathogenetic spectrum of MCD, but also extends the clinical picture of potential but rare adverse events following COVID-19 immunization.
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He Y, Hui Y, Liu H, Wu Y, Sang H, Liu F. Adult-Onset Familial Hemophagocytic Lymphohistiocytosis Presenting with Annular Erythema following COVID-19 Vaccination. Vaccines (Basel) 2022; 10:vaccines10091436. [PMID: 36146514 PMCID: PMC9501607 DOI: 10.3390/vaccines10091436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022] Open
Abstract
Familial hemophagocytic lymphohistiocytosis (HLH) is a rare genetic and life-threatening immunodeficiency disease. Here, we present a 38-year-old male who initially developed multiple annular to irregular erythema accompanied by a fever after COVID-19 vaccination. He was diagnosed with HLH with evidence of leukocytopenia in a full blood test, elevations of ferritin and sCD25, decreased NK cell function, and hemophagocytosis of a bone marrow biopsy specimen. A genetic examination revealed two probable disease-causing heterozygous mutations on UNC13D associated with type 3 familial HLH. A review of the case reports relevant to HLH following COVID-19 vaccination and the cutaneous manifestations of HLH with genetic defects suggests the necessity that individuals with preexisting immune dysregulation or diseases not classified should be cautious about COVID-19 vaccination and reminds clinicians that various recalcitrant skin lesions may be a sign of HLH.
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Affiliation(s)
- Yifan He
- Department of Dermatology, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China
| | - Yun Hui
- Department of Dermatology, Jinling Hospital, Nanjing University, Nanjing 210002, China
| | - Haibo Liu
- Department of Dermatology, Jinling Hospital, Nanjing University, Nanjing 210002, China
| | - Yifan Wu
- Department of Dermatology, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China
| | - Hong Sang
- Department of Dermatology, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China
- Department of Dermatology, Jinling Hospital, Nanjing University, Nanjing 210002, China
- Correspondence: (H.S.); (F.L.)
| | - Fang Liu
- Department of Dermatology, Jinling Hospital, Nanjing University, Nanjing 210002, China
- Correspondence: (H.S.); (F.L.)
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Finsterer J. Discrimination between Benign and Malignant Post-SARS-CoV-2 Vaccination Lymphadenopathy is Feasible. Korean J Radiol 2022; 23:773-774. [PMID: 35695321 PMCID: PMC9240297 DOI: 10.3348/kjr.2022.0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/28/2022] [Indexed: 11/15/2022] Open
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The First Case of Haemophagocytic Lymphohistiocytosis Triggered by the Booster Dose of Anti-SARS-CoV-2 Vaccine in a Patient with β-Thalassemia. THALASSEMIA REPORTS 2022. [DOI: 10.3390/thalassrep12020009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Haemophagocytic lymphohistiocytosis (HLH) is a rare and potentially life-threatening systemic hyperinflammatory disease, which can have several aetiologies. Clinical case: a 48-year-old woman affected by a transfusion-dependent β-thalassemia was hospitalized in our haematology unit presenting with intermittent fever, haepatosplenomegaly and pancytopenia, which developed a few days after the booster dose of anti-SARS-CoV-2 mRNA vaccine. The investigations performed during hospitalization led to a diagnosis of HLH and steroid therapy where IV dexamethasone was initiated and provided benefits. Conclusions: the severity of HLH mandates early treatment, but the management of patients with post-vaccine HLH is still challenging and requires further study. No cases of HLH in patients with thalassemia were previously described.
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Manifestation of Subclinical Extrapulmonary Tuberculosis after COVID-19 Vaccination as Supraclavicular Lymphadenopathy. Vaccines (Basel) 2022; 10:vaccines10060964. [PMID: 35746572 PMCID: PMC9230702 DOI: 10.3390/vaccines10060964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 12/14/2022] Open
Abstract
Lymphadenopathy after coronavirus disease 2019 (COVID-19) vaccination is a common side effect that usually resolves within several days to weeks, and only observation is recommended. However, for prolonged lymphadenopathy, other possibilities, including malignancy or other lymphoproliferative diseases, may be considered. Herein, we report the case of a 66-year-old woman who experienced prolonged ipsilateral supraclavicular lymph node enlargement after the second dose of the ChAdOx1 (Oxford-AstraZeneca) COVID-19 vaccine, which was eventually diagnosed as extrapulmonary tuberculosis.
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[Experts' consensus on severe acute respiratory syndrome coronavirus-2 vaccination in adult patients with hematological diseases in China (2022)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:359-364. [PMID: 35680591 PMCID: PMC9250963 DOI: 10.3760/cma.j.issn.0253-2727.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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AZD-1222/tozinameran. REACTIONS WEEKLY 2022. [PMCID: PMC9008617 DOI: 10.1007/s40278-022-13247-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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14
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Azzolini E, Canziani LM, Voza A, Desai A, Pepys J, De Santis M, Ceribelli A, Pozzi C, Turato M, Badalamenti S, Germagnoli L, Mantovani A, Rescigno M, Selmi C. Short-Term Adverse Events and Antibody Response to the BNT162b2 SARS-CoV-2 Vaccine in 4156 Health Care Professionals. Vaccines (Basel) 2022; 10:vaccines10030439. [PMID: 35335071 PMCID: PMC8950377 DOI: 10.3390/vaccines10030439] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/28/2022] [Accepted: 03/08/2022] [Indexed: 02/06/2023] Open
Abstract
Short-term adverse events are common following the BNT162b2 vaccine for SARS-Cov-2 and have been possibly associated with IgG response. We aimed to determine the incidence of adverse reactions to the vaccine and the impact on IgG response. Our study included 4156 health-care professionals who received two doses of the BNT162b2 vaccine 21 days apart and obtained 6113 online questionnaires inquiring about adverse events. The serum response was tested in 2765 subjects 10 days after the second dose. Adverse events, most frequently a local reaction at the site of injection, were reported by 39% of subjects. Multivariate analysis showed that female sex (odds ratio—OR—1.95; 95% confidence interval—CI—1.74−2.19; p < 0.001), younger age (OR 0.98 per year, p < 0.001), second dose of vaccine (OR 1.36, p < 0.001), and previous COVID-19 infection (OR 1.41, p < 0.001) were independently associated with adverse events. IgG response was significantly higher in subjects with adverse events (1110 AU/mL—IQR 345-1630 vs. 386 AU/mL, IQR 261-1350, p < 0.0001), and the association was more pronounced in subjects experiencing myalgia, fever, and lymphadenopathy. We demonstrate that a more pronounced IgG response is associated with specific adverse events, and these are commonly reported by health care professionals after the BNT162b2 vaccine for SARS-Cov-2.
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Affiliation(s)
- Elena Azzolini
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (E.A.); (A.V.); (A.D.); (J.P.); (M.D.S.); (A.C.); (A.M.); (M.R.)
- IRCCS Humanitas Clinical Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy; (L.M.C.); (C.P.); (M.T.); (S.B.); (L.G.)
| | - Lorenzo Maria Canziani
- IRCCS Humanitas Clinical Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy; (L.M.C.); (C.P.); (M.T.); (S.B.); (L.G.)
| | - Antonio Voza
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (E.A.); (A.V.); (A.D.); (J.P.); (M.D.S.); (A.C.); (A.M.); (M.R.)
- IRCCS Humanitas Clinical Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy; (L.M.C.); (C.P.); (M.T.); (S.B.); (L.G.)
| | - Antonio Desai
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (E.A.); (A.V.); (A.D.); (J.P.); (M.D.S.); (A.C.); (A.M.); (M.R.)
- IRCCS Humanitas Clinical Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy; (L.M.C.); (C.P.); (M.T.); (S.B.); (L.G.)
| | - Jack Pepys
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (E.A.); (A.V.); (A.D.); (J.P.); (M.D.S.); (A.C.); (A.M.); (M.R.)
| | - Maria De Santis
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (E.A.); (A.V.); (A.D.); (J.P.); (M.D.S.); (A.C.); (A.M.); (M.R.)
- IRCCS Humanitas Clinical Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy; (L.M.C.); (C.P.); (M.T.); (S.B.); (L.G.)
| | - Angela Ceribelli
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (E.A.); (A.V.); (A.D.); (J.P.); (M.D.S.); (A.C.); (A.M.); (M.R.)
- IRCCS Humanitas Clinical Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy; (L.M.C.); (C.P.); (M.T.); (S.B.); (L.G.)
| | - Chiara Pozzi
- IRCCS Humanitas Clinical Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy; (L.M.C.); (C.P.); (M.T.); (S.B.); (L.G.)
| | - Massimo Turato
- IRCCS Humanitas Clinical Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy; (L.M.C.); (C.P.); (M.T.); (S.B.); (L.G.)
| | - Salvatore Badalamenti
- IRCCS Humanitas Clinical Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy; (L.M.C.); (C.P.); (M.T.); (S.B.); (L.G.)
| | - Luca Germagnoli
- IRCCS Humanitas Clinical Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy; (L.M.C.); (C.P.); (M.T.); (S.B.); (L.G.)
| | - Alberto Mantovani
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (E.A.); (A.V.); (A.D.); (J.P.); (M.D.S.); (A.C.); (A.M.); (M.R.)
- IRCCS Humanitas Clinical Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy; (L.M.C.); (C.P.); (M.T.); (S.B.); (L.G.)
- The William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Maria Rescigno
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (E.A.); (A.V.); (A.D.); (J.P.); (M.D.S.); (A.C.); (A.M.); (M.R.)
- IRCCS Humanitas Clinical Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy; (L.M.C.); (C.P.); (M.T.); (S.B.); (L.G.)
| | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (E.A.); (A.V.); (A.D.); (J.P.); (M.D.S.); (A.C.); (A.M.); (M.R.)
- IRCCS Humanitas Clinical Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy; (L.M.C.); (C.P.); (M.T.); (S.B.); (L.G.)
- Correspondence:
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15
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Hemophagocytic lymphohistiocytosis after SARS-CoV-2 vaccination. Infection 2022; 50:1399-1404. [PMID: 35218512 PMCID: PMC8881936 DOI: 10.1007/s15010-022-01786-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/15/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic has led to the approval of novel vaccines with different mechanisms of action. Until now, more than 4.7 billion persons have been vaccinated around the world, and adverse effects not observed in pre-authorization trials are being reported at low frequency. METHODS We report a case of severe hemophagocytic lymphohistiocytosis (HLH) after SARS-CoV-2 immunization and performed a literature search for all reported cases of COVID-19 vaccine-associated HLH. RESULTS A 24-year-old female developed HLH after immunization with the mRNA COVID-19 vaccine Comirnaty. Diagnosis was made according to HLH-2004 criteria; the HScore was 259 (> 99% HLH probability) with maximum ferritin of 138.244 µg/L. The patient was initially treated with intravenous immunoglobulins (IVIGs) and dexamethasone without response. The addition of the human interleukin 1 receptor antagonist Anakinra resulted in full recovery within 6 weeks after vaccination. A literature search revealed 15 additional cases of HLH after SARS-CoV-2 vaccination, the majority after immunization with Comirnaty (n = 7) or the viral vector vaccine Vaxzevria (n = 6). Treatment modalities included corticosteroids (n = 13), Anakinra (n = 5), IVIGs (n = 5), and etoposide (n = 2). Eight patients underwent combination treatment. Three of 16 patients died. CONCLUSION COVID-19 vaccines may occasionally trigger HLH, and Anakinra may be an efficacious treatment option for this condition.
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