New-onset Adult-onset Still's Disease Following COVID-19 Vaccination: Three Case Reports and a Literature Review

Abstract

Since December 2020, coronavirus disease 2019 (COVID-19) vaccines have been distributed in most countries to prevent the onset and aggravation of COVID-19. There is little information regarding the long-term safety of the vaccines. We report three cases and a literature review of new-onset adult-onset Still's disease (AOSD) that occurred following COVID-19 vaccination. Our cases include moderate to severe AOSD, and two were complicated with macrophage activation syndrome. Seventeen cases of new-onset or relapse of AOSD following COVID-19 vaccination, including 14 identified in the literature review and our 3 patients, were all treated successfully with glucocorticoid therapy, immunosuppressive drugs, or biologic agents.

Insights into new-onset autoimmune diseases after COVID-19 vaccination

“…Adult-onset Still’s disease (AOSD) is a rare auto-inflammatory disorder of unknown etiology characterized by a high spiking fever, arthralgia, evanescent rash, and striking leucocytosis with neutrophilia [ 95 ]. A total of twenty-two cases of new-onset AOSD were reported in patients presenting with macroscopic hematuria following COVID-19 vaccination, with a male-to-female ratio of 4:7 [ [96] , [97] , [98] , [99] , [100] , [101] , [102] , [103] , [104] , [105] , [106] , [107] , [108] , [109] , [110] ]. Ten cases were reported following the mRNA vaccine, with five after the second dose, and the remainder following the viral vector vaccination, with one case reported after the second dose.…”

Occurrence of adult‐onset Still's disease after coronavirus disease 2019 BNT162B2 vaccination in a patient with ulcerative colitis: A case report and review of literature

“…This phenomenon suggests that the vaccine can cause a hyperinflammatory response. Multiple cases of new‐onset AOSD following the SARS‐CoV‐2 vaccination have been documented 9–14 . Flares of AOSD have also been reported, suggesting a possible correlation between the disease and SARS‐CoV‐2 vaccines 15–18 .…”

Occurrence of adult-onset Still's disease after coronavirus disease 2019 BNT162B2 vaccination in a patient with ulcerative colitis

“…Multiple cases of new-onset adult-onset Still's disease following SARS-CoV-2 vaccination have been documented. [8][9][10][11][12][13] Flares of adult-onset Still's disease have also been reported, suggesting a possible correlation between the disease and SARS-CoV-2 vaccines. [14][15][16][17] The reported cases of new occurrence of adult-onset Still's disease after SARS-CoV-2 vaccination, including the present case, are summarized in Table 1.…”