Case report: Acute exacerbation of interstitial pneumonia related to messenger RNA COVID-19 vaccination

Abstract

mRNA vaccines that protect against coronavirus disease (COVID-19) are widely used in many countries due to their high efficacy and safety profiles. Recently, some severe adverse events, such as anaphylaxis and myocarditis, were reported in healthy individuals. The safety of mRNA COVID-19 vaccines has not been adequately studied in patients with interstitial lung disease. We report two cases of acute exacerbation of pre-existing interstitial pneumonia associated with mRNA COVID-19 vaccination. In both cases, lung disease was stable prior to the vaccination. Initial responses to steroid therapy were unfavorable, and intravenous cyclophosphamide was administered in both cases. Both patients were diagnosed with vaccine-related exacerbation of interstitial pneumonia, based on laboratory results, radiological features, and the observed clinical course, which lacked other causative events. We suggest that clinicians should note the possibility of acute exacerbation of pneumonia after mRNA COVID-19 vaccination, and carefully monitor patients with interstitial lung disease.

Short and Long-Term Impact of COVID-19 Infection on Previous Respiratory Diseases

“…Surprisingly, some cases of acute exacerbation after COVID-19 vaccination have been described in ILDs. 191 , 192 , 193 The benefit of vaccination is over the potential side effects of the vaccine, but physicians must monitor closely those patients that present respiratory worsening after vaccination.…”

Clinical characteristics of patients with COVID-19 vaccine-related pneumonitis: a case series and literature review

“…We found 12 cases of CV-P in previously published reports through a review of the literature (Table 4) [25][26][27][28][29][30][31][32][33]. Eleven patients developed CV-P after receiving the BNT162b2-mR-NA vaccine and one after receiving the first dose of the Ch-AdOx1 nCoV-19 vaccine.…”

“… Case #1-#3, Shimizu et al [ 25 ]; Case #4, Kono et al [ 26 ]; Case #5, Matsuzaki et al [ 27 ]; Case #6 Yoshifuji et al [ 28 ]; Case #7, Piqueras et al [ 29 ]; Case #8, Stoyanov et al [ 30 ]; Case #9 and #10, Amiya et al [ 31 ]; Case #11, Wang et al [ 32 ]; Case #12 Miqdadi et al [ 33 ]. …”

“…3, Shimizu et al[25]; Case #4, Kono et al[26]; Case #5, Matsuzaki et al[27]; Case #6 Yoshifuji et al[28]; Case #7, Piqueras et al[29]; Case #8, Stoyanov et al[30]; Case #9 and #10, Amiya et al[31]; Case #11, Wang et al[32]; Case #12 Miqdadi et al [33]. COVID-19, coronavirus disease 2019; DIP, desquamative interstitial pneumonia; ILA, interstitial lung abnormality; IIP, idiopathic interstitial pneumonia; NA, not available; CT, computed tomography; NSIP, nonspecific interstitial pneumonia; OP, organizing pneumonia; DAD, diffuse alveolar damage; MPD, methylprednisolone.…”

Current Evidence in SARS-CoV-2 mRNA Vaccines and Post-Vaccination Adverse Reports: Knowns and Unknowns

“…Some reports have associated BNT162b2 vaccination with acute exacerbations of interstitial pneumonia, whereas, in the UK, 108 incidences of Interstitial Lung Disease (ILD) have been linked to the vaccine [ 88 ]. ILD has rarely occurred after the administration of some drugs or vaccines, such as influenza, and, also, the first two cases of ILD appearing after COVID-19 vaccination were Asians [ 89 ].…”