A Case of Giant Cell Arteritis Presenting After COVID-19 Vaccination: Is it Just a Coincidence?

Abstract

Giant cell arteritis (GCA) is a large vessel vasculitis with variable presentations, including fevers, myalgias, headache, and jaw claudication. A particularly concerning symptom is transient vision loss, which may become irreversible without prompt recognition and treatment. The pathogenesis of GCA is incompletely understood, but it seems that the innate and adaptive immune systems play a key role in vessel inflammation, remodeling, and occlusion. We present a case of a 79-year-old male who developed GCA two days after he received his second dose of a COVID-19 mRNA vaccine. He presented with headaches, fever, and myalgias. Lab workup revealed elevated inflammatory markers, with C-reactive protein (CRP) 272 mg/L (<8.1 mg/L) and erythrocyte sedimentation rate (ESR) 97 mm/hr (0-20mm/hr). Imaging of the head, with CT and MRI, was unremarkable. His headache persisted despite supportive treatment, and he developed new, transient blurred vision, which increased suspicion for GCA. He underwent bilateral temporal artery biopsies, which were consistent with GCA. His symptoms resolved quickly with oral prednisone 60mg daily, and his inflammatory markers returned to normal within a month. A review of the literature revealed several case reports of giant cell arteritis following influenza vaccination. However, no large-scale studies have demonstrated a causal relationship between GCA and immunization. Our case demonstrates the first instance of GCA following a COVID-19 mRNA vaccine. We propose that the upregulated immune response to the vaccine acted as a trigger for GCA in this patient with predisposing factors. While causation cannot be determined based on one case alone, our case demonstrates an opportunity for further research into the relationship between vasculitis and immunizations. Despite this isolated case, the proven benefits of COVID-19 mRNA vaccines significantly outweigh any theoretical risk of immune dysregulation following administration.

Bilateral Axillo-Brachial Artery Stenosis Following Messenger Ribonucleic Acid (mRNA) Vaccination Against Severe Acute Respiratory Coronavirus 2 (COVID-19)

“…In early 2022, several case reports of large vessel and GCA developing after mRNA COVID-19 vaccination were published with multiple authors demonstrating the utility of fluorodeoxyglucose-positron emission tomography in conjunction with computed tomography imaging for diagnosis [16][17][18][19][20][21][22][23][24].…”

Development of giant cell arteritis after vaccination against SARS-CoV2: A case report and literature review

“…Several reports have proposed a link between vaccination against SARS-CoV2 with an mRNA vaccine and the development of GCA (Table 1). [4][5][6][7][8] Six patients developed GCA after vaccination against SARS-CoV2; of those, 2 and 4 patients had received the viral vector vaccine and the mRNA vaccine, respectively. The onset time did not depend on the number of vaccinations, and all cases of GCA developed within 10 days after vaccination.…”

“…[2,3] Several previous reports have described the occurrence of GCA after vaccination against SARS-CoV2. [4–8] Herein, we report a case of GCA that developed after vaccination against SARS-CoV2.…”

A Case of Giant Cell Arteritis With a Normal Erythrocyte Sedimentation Rate (ESR) Post ChAdOx1 nCoV-19 Vaccination

“…After seven weeks of illness, she was diagnosed with GCA on a positron emission tomography (PET) scan with a CRP of 98 mg/L [ 10 ]. Other mRNA vaccine-related case reports include a 79-year-old man who developed GCA two days after his second dose of the vaccine [ 11 ], an 82-year-old man who developed bilateral GCA with skin necrosis 10 days after his second dose of vaccine [ 12 ], a new-onset GCA in an 83-year-old woman happened 24 hours after the first dose of the vaccine [ 13 ], a 63-year-old woman who developed GCA the day after the first dose of the vaccine [ 14 ], and a 78-year-old female diagnosed with large vessel vasculitis post vaccine with symptoms that started after the first shot and worsened after the second shot [ 15 ].…”