New Onset of Eosinophilic Granulomatosis with Polyangiitis Following mRNA-Based COVID-19 Vaccine

Abstract

Anti-SARS-CoV-2 vaccines are safe and effective, also in individuals with allergic and immune-mediated diseases (IMDs). There are reports suggesting that vaccines may be able to trigger de-novo or exacerbate pre-existing IMDs in predisposed individuals. Eosinophilic granulomatosis with polyangiitis (EGPA) is a small-vessel vasculitis characterized by asthma, eosinophilia, and eosinophil-rich granulomatous inflammation in various tissues. We describe the case of a 63-year-old man who experienced cardiac, pulmonary, and neurological involvement one day after the administration of the booster dose of anti-SARS-CoV-2 vaccine (mRNA-1273). A diagnosis of EGPA was made and the patient was treated with high-dose steroids and cyclophosphamide, with a good clinical response. Interestingly, our patient had experienced a significant worsening of his pre-existing asthma six months earlier, just after the first two vaccine shots with the ChAdOx1 anti-SARS-CoV-2 vaccine. It is impossible to know whether our patient would have had developed EGPA following natural SARS-CoV-2 infection or at some point in his life regardless of infectious stimuli. Nevertheless, our report may suggest that caution should be paid during the administration of additional vaccine doses in individuals who experienced an increase in IMD severity that persisted over time following previous vaccine shots.

A case of takotsubo cardiomyopathy triggered by asthma exacerbation after mRNA-based vaccination for coronavirus disease 2019

“…mRNA-based vaccines promote secretion of type I interferons and that increased interferon-I production is associated with asthma exacerbation [15,16]. Nappi et al reported a case in which two doses of the adenovirus-vectored vaccine ChAdOx1 (Astra Zeneca) progressively worsened asthma and a subsequent dose of the COVID-19 vaccine mRNA-1273 (Moderna) triggered eosinophilic granulomatosis with polyangiitis [17]. Regardless of the type of vaccine, COVID-19 vaccination itself may exacerbate asthma.…”

COVID‐19 post‐vaccination lymphadenopathy: A review of the use of fine needle aspiration cytology

“…No restrictions were placed on the year of publication. Only literature published in English was selected, including studies that reported histopathological and/or cytological findings in vaccine‐related lymphadenopathy 17,20,22,23,35–64 . Studies on SLDI, which was generally detected by 18F‐FDG PET‐CT, were also selected and used for the general comprehension and description of the phenomenon and to retrieve cases evaluated by histology or LN‐FNAC 65–68 .…”

“…While most cases of SLDI do not show clinically evident enlargement of lymph nodes, an awareness of SLDI among doctors is of fundamental importance in a variety of clinical contexts, particularly with regard to cancer staging and follow‐up to avoid the risk of overdiagnosis. In our research, surgical excision or CNB of C19‐LAP‐ or SLDI‐enlarged lymph nodes have been performed in 55 cases 20,22,23,35,39,41–43,47,49–63 . The histological diagnoses were as follows: negative for neoplasia, reactive hyperplasia, and florid reactive hyperplasia (39 cases), 23,39,50–61 progressive transformation of germinal centres (1 case), 54 atypical follicular hyperplasia with light chain‐restricted germinal centres (1 case) 62 granulomatous reaction (2 cases), 50,63 metastases (4 cases), 20,22,50 Kikuchi‐Fujimoto disease (KFD; 6 cases), 40–42,49,56,64 Rosai‐Dorfman‐Destombes disease (RDD; 1 case), 48 and Langerhans cell histiocytosis (LCH; 1 case) 57 .…”

“…In our research, surgical excision or CNB of C19-LAP-or SLDI-enlarged lymph nodes have been performed in 55 cases. 20,22,23,35,39,[41][42][43]47,[49][50][51][52][53][54][55][56][57][58][59][60][61][62][63] The histological diagnoses were as follows: negative for neoplasia, reactive hyperplasia, and florid reactive hyperplasia (39 cases), 23,39,[50][51][52][53][54][55][56][57][58][59][60][61] progressive transformation of germinal centres (1 case), 54 atypical follicular hyperplasia with light chain-restricted germinal centres (1 case) 62 granulomatous reaction (2 cases), 50,63 metastases (4 cases), 20,22,50 Kikuchi-Fujimoto disease (KFD; 6 cases), [40][41]…”

Infections and systemic vasculitis

“…Описано развитие тяжелого АНЦА-СВ в рамках постковидного синдрома спустя 1 мес после перенесенной SARS-CoV-2-инфекции [26]. Показано, что вакцинация против COVID-19 может осложняться формированием различных типов васкулитов, включая АНЦА-СВ [27][28][29].…”