Multisystem Inflammatory Syndrome in an Adult after COVID-19 Vaccination: a Case Report and Literature Review

Abstract

As the number of people vaccinated increases, people who complain of adverse reactions continue to occur. We experienced a case characterized by low blood pressure, persistent fever, edema due to increased systemic vascular permeability, and systemic inflammation confirmed by image and laboratory examinations after ChAdOx1 coronavirus disease 2019 (COVID-19) vaccination. The diagnostic criteria for multisystem inflammatory syndrome (MIS) in adults are known as fever of 3 days or more in adults, 2 or more mucocutaneous/gastrointestinal/neurologic symptoms, elevation of inflammatory markers, and clinical/imaging diagnosis of heart failure. A 67-year-old man who was medicated for hypertension and diabetes was admitted complaining of fever, maculopapular rash, diarrhea, headache, chills, and dizziness 6 days after the first vaccination of ChAdOx1 nCoV-19 in Korea. The COVID-19 test was negative but with low blood pressure, leukocytosis, skin rash, pulmonary edema, and increased inflammation markers. His lab findings and clinical course were consistent with those of MIS after COVID-19 vaccination. He was medicated with methylprednisolone 1 mg/kg and diuretics and recovered rapidly. He was discharged after 2 weeks and confirmed cure at outpatient clinic. We report an MIS case after COVID-19 vaccination in Korea.

Clinicopathological Characteristics of Inflammatory Myositis Induced by COVID-19 Vaccine (Pfizer-BioNTech BNT162b2): A Case Report

“…As more individuals were COVID-19 vaccinated, unexpected side effects appeared, making it challenging to prevent the COVID-19. 19 20 21 22 The most common systemic adverse effects were fever, fatigue, headache, and myalgia. Younger individuals reported more local or systemic adverse effects than older individuals.…”

Influence of COVID-19 vaccines on endocrine system

“…3) Systemic inflammatory response and “cytokine storm” [ 44 , 45 ]. Transient hyperglycemia following COVID-19 vaccination could result from a systemic inflammatory response [ 46 ] or a personalized reaction to vaccine components, e.g., the adenovirus system or encoded SARS-CoV-2 spike protein immunogen, the adjuvant, or the adjuvant excipients/impurities [ 30 ]. Furthermore, COVID-19 infection could cause islet cell degeneration [ 47 ].…”

A single‐center COVID‐19 vaccine experience with CoronaVac and BNT162b2 in familial Mediterranean fever patients

“…There have already been concerns for development of severe immune-mediated side effects such as myocarditis, multisystem inflammatory syndrome and Guillain-Barré syndrome related to COVID-19 vaccination, which means we should consider whether COVID-19 vaccination leads to disease flares or further adverse events in patients with rheumatic diseases. [5][6][7][8][9] Several studies have investigated vaccine safety in various rheumatic diseases with no significant safety signals; however, knowledge regarding familial Mediterranean fever (FMF) patients is still scarce. [10][11][12][13][14] FMF is an auto-inflammatory disease characterized by mutations in MEFV gene encoding pyrin, which plays an important role as a part of the innate immune system in first defense against pathogens, as a recognizer of pathogen-associated proteins or "patterns".…”

“…Patients with autoimmune and auto‐inflammatory rheumatic diseases compose a special population regarding the effects of COVID‐19 vaccines due to presence of an already dysregulated immune system and long‐term use of various immunosuppressant and anti‐inflammatory agents. There have already been concerns for development of severe immune‐mediated side effects such as myocarditis, multisystem inflammatory syndrome and Guillain‐Barré syndrome related to COVID‐19 vaccination, which means we should consider whether COVID‐19 vaccination leads to disease flares or further adverse events in patients with rheumatic diseases 5–9 . Several studies have investigated vaccine safety in various rheumatic diseases with no significant safety signals; however, knowledge regarding familial Mediterranean fever (FMF) patients is still scarce 10–14 …”